Addendum to the Supporting Statement for Site Review Questionnaire for Volume and Fee-for-Service Payees, and Beneficiary Interview Form SSA-637 and SSA-639
20 CFR 404.2035, 404.2065, 416.665, 416.701, and 416.708
OMB No. 0960-0633
Terms of Clearance
OMB approves this collection consistent with the e-mail sent by SSA on 6/5/07. As
noted in the supporting statement, SSA also agrees to adjust the burden for form SSA-624 (OMB Control No. 0960-0069) accordingly.
In compliance with the Terms of Clearance, SSA adjusted the burden for Form SSA-624 (OMB Control No. 0960-0069) per our note in the 2007 Supporting Statement. We also included a copy of the email message from 2007 in which we answered OMB’s questions regarding this collection.
Revision to the Collection Instrument
SSA is making the following revision:
SSA’s Office of the General Counsel is conducting a systematic review of SSA’s Privacy Act Statement on agency forms. As a result, SSA is adding a Privacy Act Statement to this form.
| File Type | application/msword |
| File Title | Addendum to the Supporting Statement for Form SSA 4641 U2 |
| Author | 177717 |
| Last Modified By | 177717 |
| File Modified | 2010-01-06 |
| File Created | 2009-12-10 |