Information Collection

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

IC 197206 under ICR 201610-0960-006 · 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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
Document Name	Document Type
Form SSA-820-BK Work Activity Report (Self-Employed Person) - Completing Partial Form	Form
SSA-820-BK WORK ACTIVITY REPORT (Self-Employed Person) SSA-820-BK.pdf www.socialsecurity.gov	Form

IC Title:

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

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Removed

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 404.1571-.1571 20 CFR 404.150(b) 20 CFR 416.971-.976 20 CFR 404.1854-.1593

Information Collection Instruments:

table that charts list of 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-Employed Person)	SSA-820-BK.pdf	www.socialsecurity.gov	Yes	Yes	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: Federal Government

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	-50,000	50,000
Annual IC Time Burden (Hours)	-12,500	12,500
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.