Information Collection

Work Activity Report (Self-Employed Person) - Completing Entire Form

IC 9580 under ICR 201309-0960-002 · 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⚠️ Notice: This information collection may be referencing outdated material.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

Document Name Document Type
Form SSA-820-BK Work Activity Report (Self-Employed Person) - Completing Entire Form Form
SSA-820-BK Work Activity Report (Self-Employment) SSA-820-BK.pdf www.socialsecurity.gov Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Work Activity Report (Self-Employed Person) - Completing Entire Form	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 404.1520(b) 20 CFR 404.1584-.1593 20 CFR 404.1571-1576 20 CFR 416.971-.976

Information Collection 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-Employment)	SSA-820-BK.pdf	www.socialsecurity.gov	Yes	No	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: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	50,000	50,000
Annual IC Time Burden (Hours)	25,000	25,000
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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