Work Activity Report (Self-Employment)

Forms and Documents

Document Name	Status
Form SSA-820-BK Work Activity Report (Self-Employed Person) Form	Modified
Form SSA-820-BK Work Activity Report (Self-Employed Person) - Completing Partial Form Form	Removed
Addendum - 0598.docx Supplementary Document	2017-03-23
Supporting Statement - 0598.docx Supporting Statement A	2017-03-23

IC Document Collections

IC ID	Document Title	Status
9580	Work Activity Report (Self-Employed Person) Form	Modified
197206	Work Activity Report (Self-Employed Person) - Completing Partial Form Form	Removed

ICR Details

OMB Control No: 0960-0598	ICR Reference No: 201610-0960-006
Status: Historical Active	Previous ICR Reference No: 201309-0960-002
Agency/Subagency: SSA	Agency Tracking No:
Title: Work Activity Report (Self-Employment)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 10/27/2017
	Date Received in OIRA: 03/23/2017
Terms of Clearance: In accordance with 5 CFR 1320, the information collection is approved for three years.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2020	36 Months From Approved	10/31/2017
Responses	100,000	0	100,000
Time Burden (Hours)	50,000	0	37,500
Cost Burden (Dollars)	0	0	0

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Abstract: SSA uses Form SSA-820-BK to determine initial or continuing eligibility for (1) Title II Social Security disability payments, or (2) Title XVI Supplemental Security Income (SSI) payments. Under Titles II and XVI of the Act, recipients receive disability and SSI payments based on their inability to engage in substantial gainful activity (SGA) due to a physical or mental condition. Therefore, when the recipients resume work, they must report their work so SSA can evaluate and determine by law whether they continue to meet the disability requirements. SSA uses Form SSA-820-BK to obtain information on self-employment activities of Social Security Title II and XVI disability applicants and recipients. We use the data we obtain to evaluate disability claims, and to help us determine if the claimant meets current disability provisions under Titles II and XVI. Since applicants for disability or SSI payments must prove an inability to perform any kind of SGA generally available in the national economy for which we expect them to qualify based on age, education, and work experience, any work an applicant performed until, or subsequent to, the date the disability allegedly began, affects our disability determination. The respondents are applicants and claimants for Social Security disability payments or SSI payments.

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Authorizing Statute(s): US Code: 42 USC 1383b Name of Law: The Social Security Act
   US Code: 42 USC 423 Name of Law: The Social Security Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 80159	11/15/2016
30-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 10623	02/14/2017
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Work Activity Report (Self-Employed Person)	SSA-820-BK	Work Activity Report (Self-Employment)
Work Activity Report (Self-Employed Person) - Completing Partial Form	SSA-820-BK	WORK ACTIVITY REPORT (Self-Employed Person)

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ICR Summary of Burden

	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	100,000	100,000	0	0	0	0
Annual Time Burden (Hours)	50,000	37,500	0	0	12,500	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: There are no changes or adjustments to the number of respondents; however, we noted that all the respondents fill out the entire form each time, so we removed the burden data for respondents who fill out only part of the form. This resulted in an increase in burden hours, which reflects actual management information data.

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Annual Cost to Federal Government: $200,000

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 03/23/2017

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