Information Collection

Work Activity Report - Self-Employment (returned via mail)

IC 9580 under ICR 202504-0960-004 · OMB 0960-0598.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-820-BK Work Activity Report - Self-Employment (returned via mail)	Form
Form SSA-820-BK Work Activity Report (Self-Employment) Work Activity Report - Self-Employment (returned via mail)	Form
SSA-820-BK Work Activity Report (Self-Employment) SSA-820-BK - DRAFT (Revised Version).pdf	Form
SSA-820-BK Work Activity Report (Self-Employment) SSA-820-BK - DRAFT (Revised Version).pdf	Form
SSA-820-BK (Current Version).pdf SSA-820-BK - Current Version	IC Document
SSA-820-BK (Current Version).pdf SSA-820-BK - Current Version	IC Document

IC Title:

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			www.socialsecurity.gov	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: 49,895

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	49,895	1,324	48,571
Annual IC Time Burden (Hours)	62,369	17,846	44,523
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
SSA-820-BK - Current Version		01/08/2026

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

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