Information Collection

Work Activity Report (Self-Employed Person), 20 CFR 404.1520(b), 404.1571-.1576, 404.1584-.1593, 416.971-.976

IC 197206 under ICR 201110-0960-001 · OMB 0960-0598.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0598 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-820-BK Work Activity Report (Self-Employed Person), 20 CFR 404.1520(b), 404.1571-.1576, 404.1584-.1593, 416.971-.976	Form
SSA-820-BK WORK ACTIVITY REPORT (Self-Employed Person) SSA-820 (revised).pdf	Form
SSA-821-BK (current).pdf Work Activity Report (Self-Employed Person)	IC Document

IC Title:

Work Activity Report (Self-Employed Person), 20 CFR 404.1520(b), 404.1571-.1576, 404.1584-.1593, 416.971-.976

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 404.1571-.1571 20 CFR 404.1854-.1593 20 CFR 416.971-.976 20 CFR 404.150(b)

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SSA-820-BK	WORK ACTIVITY REPORT (Self-Employed Person)	SSA-820 (revised).pdf		Yes	Yes	Fillable Printable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 50,000

Number of Respondents for Small Entity: 0

Affected Public: Federal Government

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	50,000	50,000
Annual IC Time Burden (Hours)	12,500	12,500
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Work Activity Report (Self-Employed Person)	SSA-821-BK (current).pdf	10/04/2011

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