Information Collection

Work Activity Report - Self-Employment (paper form)

IC 9580 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⚠️ Notice: This information collection may be referencing outdated material.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

Document Name Document Type
Form SSA-820-BK Work Activity Report - Self-Employment (paper form) Form
Work CDR Sample Notice.pdf Other-Work CDR Sample Notice
Work CDR Sample Notice.pdf Other-Work CDR Sample Notice
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 Work Activity Report (Self-Employment) SSA-820-BK (revised).pdf www.socialsecurity.gov Form
SSA-820-BK Work Activity Report (Self-Employment) SSA-820-BK (revised).pdf www.socialsecurity.gov Form
SSA-820-BK (current).pdf SSA-820-BK (current) IC Document
SSA-820-BK (current).pdf SSA-820-BK (current) IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Work Activity Report - Self-Employment (paper form)	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 404.1571-404.1576 20 CFR 404.1584-404.1593 20 CFR 416.971-416.976

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-Employment)	SSA-820-BK (revised).pdf	www.socialsecurity.gov	Yes	No	Fillable Printable
Other-Work CDR Sample Notice			Work CDR Sample Notice.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: 48,571	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	48,571	-51,429	100,000
Annual IC Time Burden (Hours)	44,523	-5,477	50,000
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
SSA-820-BK (current)	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.