Work Activity Report--Employee

ICR 201505-0960-008

OMB: 0960-0059

Federal Form Document

Forms and Documents
Document
Name
Status
Form
Modified
Supplementary Document
2015-07-30
Supporting Statement A
2015-07-31
IC Document Collections
IC ID
Document
Title
Status
8980 Modified
ICR Details
0960-0059 201505-0960-008
Historical Active 201204-0960-020
SSA
Work Activity Report--Employee
Reinstatement with change of a previously approved collection   No
Regular
Approved without change 10/22/2015
Retrieve Notice of Action (NOA) 07/31/2015
SSA must report this collection as a violation in the Information Collection Budget unless it show the form was not in use before this reinstatement.
  Inventory as of this Action Requested Previously Approved
10/31/2018 36 Months From Approved
300,000 0 0
150,000 0 0
0 0 0

Form SSA-821-BK is used by SSA field offices to: obtain work information from recipients' during face-to-face and telephone interviews, or by mail; during the initial claims process, during the continuing disability review process, and whenever a work issues arises in SSI claims. SSA's processing centers Office of Disability and International Operations use the form to obtain post-adjudicative work issue from recipients' by mail. The primary purpose of this form is to collect information concerning whether recipients' have worked in employment after becoming disabled and, if so, whether the work is substantial gainful activity (SGA). SSA will review and evaluate the data to determine if the recipient continues to meet the disability requirement of the law. The respondents are Social Security disability applicants, beneficiaries, and Supplemental Security Income applicants.

US Code: 42 USC 1383b Name of Law: Social Security Act
   US Code: 42 USC 423 Name of Law: Social Security Act
  
None

Not associated with rulemaking

  80 FR 29787 05/22/2015
80 FR 43828 07/23/2015
No

1
IC Title Form No. Form Name
Work Activity Report--Employee SSA-821-BK Work Activity Report- Employee

  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 300,000 0 0 0 0 300,000
Annual Time Burden (Hours) 150,000 0 0 0 0 150,000
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$2,310,000
No
No
No
No
No
Uncollected
Faye Lipsky 410 965-8783 [email protected]

  No

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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
07/31/2015


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