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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
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

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:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.