SSA-821-BK - Electronic

Work Activity Report--Employee

Documents and Forms

Document Name Document Type
Form SSA-821-APP SSA-821-BK - Electronic Form
SSA-821 - Revised PA & PRA Statements.pdf Other-Revised Privacy Act and PRA St
SSA-821-APP Work Activity Report – Employee SSA-821-APP - Screen Package.pdf www.ssa.gov Form

Information Collection (IC) Details

IC Title:	SSA-821-BK - Electronic	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 416.971-976 20 CFR 404.1520(b) 20 CFR 404.1584-1593 20 CFR 404.1571-1576

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SSA-821-APP	Work Activity Report – Employee	SSA-821-APP - Screen Package.pdf	www.ssa.gov	Yes	No	Fillable Fileable Signable
Other-Revised Privacy Act and PRA Statements			SSA-821 - Revised PA & PRA Statements.pdf		Yes	No	Printable Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 25,320	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	25,320	25,320
Annual IC Time Burden (Hours)	25,320	25,320
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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