Addendum to the Supporting Statement

Addendum to the Supporting Statement for Form SSA.doc

Work Activity Report--Employee

Addendum to the Supporting Statement

OMB: 0960-0059

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Addendum to the Supporting Statement for Form SSA-821-BK,

Work Activity Report—Employee

20 CFR 404.1520(b), 404.1571-.1576, 404.1584-.1593 and 416.971-.976

(OMB No. 0960-0059)




Minor Revisions to the Collection Instrument


SSA is making the following revisions:


We are revising the PRA statement to reflect our current boilerplate language.  The current language, which dates back to the last reprint of the form, is now outdated.


SSA’s Office of the General Counsel is conducting a systematic review of SSA’s Privacy Act Statements on agency forms. As a result, SSA is updating the Privacy Act Statement on the first page of the form.



File Typeapplication/msword
File TitleAddendum to the Supporting Statement for Form SSA-821-BK,
AuthorMandley, Tasha
Last Modified ByMandley, Tasha
File Modified2009-01-14
File Created2009-01-14

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