Site Review Questionnaires for Volume and Fee-for-Service Payees and Beneficiary Interview Form

ICR 201209-0960-008

OMB: 0960-0633

Federal Form Document

ICR Details
0960-0633 201209-0960-008
Historical Active 200911-0960-004
SSA
Site Review Questionnaires for Volume and Fee-for-Service Payees and Beneficiary Interview Form
Revision of a currently approved collection   No
Regular
Approved without change 01/31/2013
Retrieve Notice of Action (NOA) 12/12/2012
  Inventory as of this Action Requested Previously Approved
01/31/2016 36 Months From Approved 04/30/2013
10,292 0 11,342
5,380 0 5,559
0 0 0

SSA uses the SSA-637, Site Review Questionnaire for Volume and Fee-for-Service Payees, to obtain information from payees about how the organization operates and carries out its representative payee responsibilities, including how it manages beneficiary funds. We then use the SSA-639, Beneficiary Interview Form, to obtain information from the beneficiaries to help corroborate the payee's statements. Due to the sensitivity of the information, SSA employees always complete the forms based on the answers respondents give during the interview. This collection is mandatory for representative payees and voluntary for beneficiaries. SSA will not allow representative payees who do not respond to continue serving as representative payees. The respondents are individuals, State and local governments, non-profit and for-profit organizations that serve as representative payees and the beneficiaries they serve.

US Code: 42 USC 405 Name of Law: The Social Security Act
   US Code: 42 USC 1383 Name of Law: The Social Security Act
   PL: Pub.L. 108 - 203 102(b) Name of Law: The Social Security Protection Act
  
None

Not associated with rulemaking

  77 FR 58903 09/24/2012
77 FR 73112 12/07/2012
No

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 10,292 11,342 0 0 -1,050 0
Annual Time Burden (Hours) 5,380 5,559 0 0 -179 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
The decrease in burden to 5,380 hours stems from a policy change; we now review volume payees every four years instead of every three years.

$233,069
No
No
No
No
No
Uncollected
Faye Lipsky 410 965-8783 [email protected]

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
12/12/2012


© 2024 OMB.report | Privacy Policy