OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

WORK ACTIVITY REPORT, SELF-EMPLOYED PERSON, WORK ACTIVITY REPORT, EMPLOYEE

ICR 199306-0960-002 · OMB 0960-0059 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC IDCollectionTypeStatusForm
114471 WORK ACTIVITY REPORT, SELF-EMPLOYED PERSON, WORK ACTIVITY REPORT, EMPLOYEE Form Migrated
ICR Details
0960-0059 199306-0960-002
Historical Active 199003-0960-003
SSA
WORK ACTIVITY REPORT, SELF-EMPLOYED PERSON, WORK ACTIVITY REPORT, EMPLOYEE
Revision of a currently approved collection   No
Regular
Approved without change 08/31/1993
Retrieve Notice of Action (NOA) 06/15/1993
  Inventory as of this Action Requested Previously Approved
08/31/1996 08/31/1996 06/30/1993
250,000 0 200,000
125,000 0 100,000
0 0 0
THE INFORMATION COLLECTED BY THESE FORMS IS NEEDED TO HELP DETERMINE IF AN INDIVIDUAL CAN MEET THE DISABILITY PROVISIONS FOR INITIAL OR CONTINUING ENTITLEMENT TO SOCIAL SECURITY DISABILITY BENEFITS. THE AFFECTED PUBLIC CONSISTS OF APPLICANTS OR CLAIMANTS FOR DISABILITY BENEFITS WHO ARE OR WERE ENGAGING IN SUBSTANTIAL GAINFUL ACTIVITY.
None
None
No
1
IC Title Form No. Form Name
WORK ACTIVITY REPORT, SELF-EMPLOYED PERSON, WORK ACTIVITY REPORT, EMPLOYEE SSA-820, 821
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 250,000 200,000 0 0 50,000 0
Annual Time Burden (Hours) 125,000 100,000 0 0 25,000 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected
  No
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
06/15/1993