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

ICR 202108-0960-001

OMB: 0960-0633

Federal Form Document

ICR Details
0960-0633 202108-0960-001
Received in OIRA 201808-0960-001
Site Review Questionnaires for Volume and Fee-for-Service Payees and Beneficiary Interview Form
Revision of a currently approved collection   No
Regular 01/12/2022
  Requested Previously Approved
36 Months From Approved 02/28/2022
27,000 26,696
13,667 13,477
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 serving as representative payees; and the beneficiaries they serve.

PL: Pub.L. 108 - 203 102(b) Name of Law: The Social Security Protection Act
   US Code: 42 USC 405 Name of Law: The Social Security Act
   US Code: 42 USC 1383 Name of Law: The Social Security Act

Not associated with rulemaking

  86 FR 56746 10/12/2021
87 FR 139 01/03/2022

  Total Request 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 27,000 26,696 0 0 304 0
Annual Time Burden (Hours) 13,667 13,477 0 0 190 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
When we last cleared this IC, the burden was 13,477 hours. However, we are currently reporting a burden of 13,667 hours. This change stems from an increase in the number of responses from 26,696 to 27,000. There is no change to the burden time per response. Although the number of responses changed, SSA did not take any actions to cause this change. These figures represent current Management Information data.

Faye Lipsky 410 965-8783 [email protected]


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.

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