Expanded Monitoring Site Review: Beneficiary Interview Form

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 10 minutes 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.