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Beneficiary Interview and Auditor's Observations
Beneficiary Interview and Auditor's Observations
OMB: 0960-0630
IC ID: 9653
OMB.report
SSA
OMB 0960-0630
ICR 201511-0960-015
IC 9653
( )
Documents and Forms
Document Name
Document Type
Form SSA-322
Beneficiary Interview and Auditor's Observations
Form
SSA-322 Beneficiary Interview and Auditor's Observations
SSA-322 (revised).pdf
Form
SSA-322 (current).pdf
Beneficiary Interview and Auditor's Observations (current)
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Beneficiary Interview and Auditor's Observations
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Modified
Obligation to Respond:
Voluntary
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form
SSA-322
Beneficiary Interview and Auditor's Observations
SSA-322 (revised).pdf
No
Paper Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
Income Security
Subfunction:
General Retirement and Disability
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
1,000
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
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
1,000
0
0
0
0
1,000
Annual IC Time Burden (Hours)
250
0
0
0
0
250
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Beneficiary Interview and Auditor's Observations (current)
SSA-322 (current).pdf
11/24/2015
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
