Beneficiary Interview and Auditor's Observations

Forms and Documents

Document Name	Status
Form SSA-322 Beneficiary Interview and Auditor's Observations Form	Unchanged
Privacy Act Statement - Beneficiary Interview and Auditor's Observations - OCIG - Revision(3).docx Supplementary Document	2010-08-25
Justification for a Non-Substantive Change.doc Justification for No Material/Nonsubstantive Change	2010-08-25

IC Document Collections

IC ID	Document Title	Status
9653	Beneficiary Interview and Auditor's Observations Form	Unchanged

ICR Details

OMB Control No: 0960-0630	ICR Reference No: 201008-0960-011
Status: Historical Active	Previous ICR Reference No: 201002-0960-019
Agency/Subagency: SSA	Agency Tracking No:
Title: Beneficiary Interview and Auditor's Observations
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 09/30/2010
	Date Received in OIRA: 08/26/2010
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2013	07/31/2013	07/31/2013
Responses	200	0	200
Time Burden (Hours)	50	0	50
Cost Burden (Dollars)	0	0	0

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Abstract: SSA’s Office of the Inspector General (OIG) will use the information collected through Form SSA-322, the Beneficiary Interview and Auditor’s Observation form, to interview beneficiaries and /or their payees to determine if they are complying with their duties and responsibilities. SSA will randomly select SSI recipients Social Security beneficiaries who have representative payees as respondents for this collection. In this non-substantive change request, we are updating the Privacy Act statement as per SSA's Office of General Counsel.

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Authorizing Statute(s): US Code: 42 USC 405 Name of Law: Social Security Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	75 FR 3778	01/22/2010
30-day Notice:	Federal Register Citation:	Citation Date:
	75 FR 15761	03/30/2010
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Beneficiary Interview and Auditor's Observations	SSA-322	Beneficiary Interview and Auditor's Observations

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ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	200	200	0	0	0	0
Annual Time Burden (Hours)	50	50	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $4,279

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 08/26/2010

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