Site Review Questionnaires for Volume and Fee-for-Service Payees

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

SSA-637 revised PRA

Site Review Questionnaires for Volume and Fee-for-Service Payees

OMB: 0960-0633

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SSA will insert the following revised PRA Statement into the form as soon as possible:



Paperwork Reduction Act Statement - This information collection meets the requirements of 44 U.S.C. § 3507, as amended by section 2 of the Paperwork Reduction Act of 1995.  You do not need to answer these questions unless we display a valid Office of Management and Budget (OMB) control number.  We estimate that it will take about 2 hours to read the instructions, gather the facts, and answer the questions.  Send only comments relating to our time estimate above to:  SSA, 6401 Security Blvd, Baltimore, MD  21235-6401.

File Typeapplication/msword
File TitlePaperwork Reduction Act Statements
AuthorCraig Hartson
Last Modified By889123
File Modified2015-09-29
File Created2015-09-29

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