OMB.report

Federal forms, ICRs, and supporting documents

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
Document Name
Document Type
Form
Form
Other-Revised PA & PRA Statements
Other-Revised PA & PRA Statements
Form
Form
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Site Review Questionnaires for Volume and Fee-for-Service Payees
 
No Modified
 
Required to Obtain or Retain Benefits
 
20 CFR 416.665 20 CFR 404.2035 20 CFR 416.701 20 CFR 416.708 20 CFR 404.2065

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 Yes Yes Fillable Printable
Other-Revised PA & PRA Statements SSA-637 - Revised PA & PRA Statements.pdf Yes Yes Fillable Printable

Income Security General Retirement and Disability

 

5,000 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   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 5,000 0 0 76 0 4,924
Annual IC Time Burden (Hours) 10,000 0 0 152 0 9,848
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
SSA-637 - Current SSA-637 - Current.pdf 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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