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⚠️ Notice: This information collection may be referencing outdated material.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

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

Information Collection (IC) Details

View Information Collection (IC)

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:

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 %

	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

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.