Information Collection

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

IC 38057 under ICR 202108-0960-001 · OMB 0960-0633.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-637 Site Review Questionnaires for Volume and Fee-for-Service Payees	Form
Form SSA-637 Expanded Monitoring Site Review Questionnaire for Volume and Fee for Service Payees Site Review Questionnaires for Volume and Fee-for-Service Payees	Form
SSA-637 - Revised PA & PRA Statements.pdf	Other-Revised PA & PRA Statements
SSA-637 - Revised PA & PRA Statements.pdf	Other-Revised PA & PRA Statements
SSA-637 Expanded Monitoring Site Review Questionnaire for Volume SSA-637 - Revised.pdf	Form
SSA-637 Expanded Monitoring Site Review Questionnaire for Volume SSA-637 - Revised.pdf	Form
SSA-637 - Current.pdf SSA-637 - Current	IC Document
SSA-637 - Current.pdf SSA-637 - Current	IC Document

IC Title:

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:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SSA-637				Yes	Yes	Fillable Printable
Other-Revised PA & PRA Statements					Yes	Yes	Fillable Printable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 5,000

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	5,000	76	4,924
Annual IC Time Burden (Hours)	10,000	152	9,848
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
SSA-637 - Current		01/11/2022

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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