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Site Review Questionnaires for Volume and Fee-for-Service Payees
Site Review Questionnaires for Volume and Fee-for-Service Payees and Beneficiary Interview Form
OMB: 0960-0633
IC ID: 38057
OMB.report
SSA
OMB 0960-0633
ICR 201808-0960-001
IC 38057
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0633 can be found here:
2022-01-12 - Revision of a currently approved collection
Documents and Forms
Document Name
Document Type
Form SSA-637
Site Review Questionnaires for Volume and Fee-for-Service Payees
Form
Revised PA Statement.pdf
Other-Revised PA Statement
SSA-637 Expanded Monitoring Site Review Questionnaire for Volume
SSA-637 - Revised.pdf
Form
SSA-637 - Current.pdf
Current SSA-637
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Site Review Questionnaires for Volume and Fee-for-Service Payees
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Modified
Obligation to Respond:
Required to Obtain or Retain Benefits
CFR Citation:
20 CFR 416.665
20 CFR 404.2035
20 CFR 416.701
20 CFR 416.708
20 CFR 404.2065
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form
SSA-637
Expanded Monitoring Site Review Questionnaire for Volume and Fee for Service Payees
SSA-637 - Revised.pdf
No
Fillable Printable
Other-Revised PA Statement
Revised PA Statement.pdf
No
Fillable Printable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Income Security
Subfunction:
General Retirement and Disability
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
4,924
Number of Respondents for Small Entity:
0
Affected Public:
Private Sector
Private Sector:
Not-for-profit institutions, Businesses or other for-profits
Percentage of Respondents Reporting Electronically:
0 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
4,924
0
0
2,925
0
1,999
Annual IC Time Burden (Hours)
9,848
0
0
5,850
0
3,998
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Current SSA-637
SSA-637 - Current.pdf
10/17/2018
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.