Work Activity Report--Employee

ICR 202111-0960-004

OMB: 0960-0059

Federal Form Document

Forms and Documents
Document
Name
Status
Form
Modified
Supplementary Document
2021-11-19
Supporting Statement A
2021-11-22
IC Document Collections
IC ID
Document
Title
Status
8980 Modified
ICR Details
0960-0059 202111-0960-004
Received in OIRA 202108-0960-003
SSA
Work Activity Report--Employee
Revision of a currently approved collection   No
Regular 11/22/2021
  Requested Previously Approved
36 Months From Approved 12/31/2021
411,300 300,000
205,650 150,000
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.

US Code: 42 USC 423 Name of Law: Social Security Act
   US Code: 42 USC 1383b Name of Law: Social Security Act
  
None

Not associated with rulemaking

  86 FR 47190 08/23/2021
86 FR 64585 11/18/2021
No

1
IC Title Form No. Form Name
Work Activity Report--Employee SSA-821-BK, SSA-821-APP (Submittable PDF) Work Activity Report- Employee ,   Work Activity Report- Employee

  Total Request 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 411,300 300,000 0 0 111,300 0
Annual Time Burden (Hours) 205,650 150,000 0 0 55,650 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
When we last cleared this IC in 2018, the burden was 150,000 hours. However, we are currently reporting a burden of 205,650 hours. This change stems from an increase in the number of responses from 300,000 to 411,300. There is no change to the burden time per response. Although the number of responses changed, SSA did not take any actions to cause this change. These figures represent current Management Information data.

$2,321,284
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.
11/22/2021


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