Information Collection

Work Activity Report--Employee

IC 8980 under ICR 202111-0960-004 · OMB 0960-0059.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0059 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-821-BK Work Activity Report--Employee	Form
Revised PA & PRA Statements.pdf	Other-Revised PA & PRA Statements
Revised PA & PRA Statements.pdf	Other-Revised PA & PRA Statements
SSA-821-BK Work Activity Report- Employee SSA-821-BK.pdf	Form
SSA-821-BK Work Activity Report- Employee SSA-821-BK.pdf	Form
SSA-821-APP (Submi Work Activity Report- Employee SSA-821-APP - Screen Package.pdf	Form and Instruction
SSA-821-APP (Submi Work Activity Report- Employee SSA-821-APP - Screen Package.pdf	Form and Instruction
SSA-821-BK - Current.pdf SSA-821-BK - Current	IC Document
SSA-821-BK - Current.pdf SSA-821-BK - Current	IC Document

IC Title:

Work Activity Report--Employee

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 404.1520(b) 20 CFR 404.1584-1593 20 CFR 404.1571-1576 20 CFR 416.971-976

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SSA-821-BK	Work Activity Report- Employee	SSA-821-BK.pdf	Yes	No	Fillable Printable
Form and Instruction	SSA-821-APP (Submittable PDF)	Work Activity Report- Employee	SSA-821-APP - Screen Package.pdf	Yes	Yes	Fillable Fileable Signable
Other-Revised PA & PRA Statements			Revised PA & PRA Statements.pdf	Yes	No	Fillable Printable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 411,300

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	411,300	111,300	300,000
Annual IC Time Burden (Hours)	205,650	55,650	150,000
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
SSA-821-BK - Current	SSA-821-BK - Current.pdf	11/12/2021

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.