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

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

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0633 can be found here:

Documents and Forms

Document Name Document Type
Form SSA-637--revised Site Review Questionnaires for Volume and Fee-for-Service Payees Form
SSA-637--revised Expanded Monitoring Site Review Questionnaire for Volume SSA-637--Revised.doc Form

Information Collection (IC) Details

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 416.708 20 CFR 404.2065 20 CFR 416.665 20 CFR 416.701 20 CFR 404.2035

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SSA-637--revised	Expanded Monitoring Site Review Questionnaire for Volume and Fee for Service Payees	SSA-637--Revised.doc		No		Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,747	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 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	1,747	-6,113	7,860
Annual IC Time Burden (Hours)	3,494	1,068	2,426
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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