Information Collection

Work Activity Report (Self-Employment) - In Office

IC 261603 under ICR 202308-0960-003 · 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⚠️ Notice: This information collection may be referencing outdated material.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
SSA-820-BK (revised).pdf	Other-SSA-820-BK (revised)
SSA-820-BK (revised).pdf	Other-SSA-820-BK (revised)
0960-0598 Privacy Act Statement (revised).docx	Other-Privacy Act Statement (revised
0960-0598 Privacy Act Statement (revised).docx	Other-Privacy Act Statement (revised
SSA-820-BK (current).pdf SSA-820-BK (revised)	IC Document
SSA-820-BK (current).pdf SSA-820-BK (revised)	IC Document

IC Title:

Work Activity Report (Self-Employment) - In Office

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 404.1520(b) 20 CFR 404.1571-404.1576 20 CFR 404.1584-404.1593 20 CFR 416.971-416.976

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
Other-SSA-820-BK (revised)			SSA-820-BK (revised).pdf		No		Paper Only
Other-Privacy Act Statement (revised)			0960-0598 Privacy Act Statement (revised).docx		No		Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 12,144

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
Annual Number of Responses for this IC	12,144	12,144
Annual IC Time Burden (Hours)	15,180	15,180
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
SSA-820-BK (revised)	SSA-820-BK (current).pdf	11/20/2023

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