Work Activity Report--Employee

ICR 202008-0960-020

OMB: 0960-0059

Federal Form Document

Forms and Documents
Document
Name
Status
Form
Modified
Justification for No Material/Nonsubstantive Change
2020-08-27
Supporting Statement A
2018-10-08
IC Document Collections
IC ID
Document
Title
Status
8980 Modified
ICR Details
0960-0059 202008-0960-020
Active 201806-0960-004
SSA
Work Activity Report--Employee
No material or nonsubstantive change to a currently approved collection   No
Regular
Approved without change 09/28/2020
Retrieve Notice of Action (NOA) 08/27/2020
  Inventory as of this Action Requested Previously Approved
12/31/2021 12/31/2021 12/31/2021
300,000 0 300,000
150,000 0 150,000
0 0 0

SSA uses Form SSA-821-BK to collect employment information to determine whether individuals have worked after becoming disabled and, if so, whether the work is SGA. We use the information to make a determination of eligibility for disability payments. Specifically, we use Form SSA-821-BK to obtain information from individuals during the initial SSI and SSDI claims process; the Continuing Disability Review (CDR) process; and appeals involving work issues. An SSA employee may fill out the form during an in office or telephone interview, or the applicants or recipients may fill it out themselves. SSA reviews and evaluates the data to determine if the applicant or recipient meets the disability requirements of the law. If respondents work when they apply for benefits, they must complete this collection to obtain SSI or SSDI. The respondents are SSDI applicants or recipients, and SSI applicants. We are making minor revisions the form and the notices.

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

  83 FR 31987 07/10/2018
83 FR 49965 10/03/2018
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 300,000 300,000 0 0 0 0
Annual Time Burden (Hours) 150,000 150,000 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$232,000
No
    Yes
    Yes
No
No
No
No
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.
08/27/2020


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