Information Collection

Work Activity Report--Employee

IC 8980 under ICR 201505-0960-008 · OMB 0960-0059.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0059 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-821-BK Work Activity Report--Employee	Form
Revised Privacy Act Statement.doc	Other-Revised Privacy Act Statement
PRA revised.doc	Other-Revised Paperwork Reduction Ac
SSA-821-BK Work Activity Report- Employee SSA-821 (revised).pdf	Form
SSA-821-BK (current).pdf SSA-821-BK (current)	IC Document

IC Title:

Work Activity Report--Employee

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

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SSA-821-BK	Work Activity Report- Employee	SSA-821 (revised).pdf	Yes	No	Fillable Printable
Other-Revised Privacy Act Statement			Revised Privacy Act Statement.doc	No		Paper Only
Other-Revised Paperwork Reduction Act			PRA revised.doc	No		Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 300,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	300,000	300,000
Annual IC Time Burden (Hours)	150,000	150,000
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
SSA-821-BK (current)	SSA-821-BK (current).pdf	05/26/2015

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