SSA-820 and SSA-821

Quality Review Case Analysis: Sample Number Holder; Auxiliaries/Survivors; Parent; Stewardship Annual Earnings Test Workbook

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0189 can be found here:

Documents and Forms

Document Name Document Type
Form SSA-820-F4 SSA-820 and SSA-821 Form
SSA-820-F4 Work Activity Report (Self-Employed Person) SSA-820 Final.pdf Form
SSA-821-BK Work Activity Report-Employee ssa821bk.pdf Form
ssa820.pdf SSA-820-F4 IC Document

Information Collection (IC) Details

IC Title:	SSA-820 and SSA-821	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SSA-820-F4	Work Activity Report (Self-Employed Person)	SSA-820 Final.pdf		No		Paper Only
Form	SSA-821-BK	Work Activity Report-Employee	ssa821bk.pdf		No		Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 400	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	400	400
Annual IC Time Burden (Hours)	100	100
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
SSA-820-F4	ssa820.pdf	03/17/2011

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