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Federal forms, ICRs, and supporting documents

Information Collection Request

Work Activity Report--Employee 20 CFR 404.1520(b), 404.1571-.1576, 404.1584-.1593 and 416.971-.976

ICR 200603-0960-010 · 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
8980 Work Activity Report--Employee 20 CFR 404.1520(b), 404.1571-.1576, 404.1584-.1593 and 416.971-.976 Form Migrated
ICR Details
0960-0059 200603-0960-010
Historical Active 200302-0960-003
SSA
Work Activity Report--Employee 20 CFR 404.1520(b), 404.1571-.1576, 404.1584-.1593 and 416.971-.976
Extension without change of a currently approved collection   No
Regular
Approved without change 06/27/2006
Retrieve Notice of Action (NOA) 03/22/2006
In reviewing its electronic forms process, SSA agrees to consider this form as a candidate for electronic submission. Upon resubmission of this form for OMB approval, SSA will either: 1) make this form electronically available; or 2) provide OMB with a detailed explanation of why electronic submission was not feasible.
  Inventory as of this Action Requested Previously Approved
06/30/2009 06/30/2009 06/30/2006
300,000 0 300,000
225,000 0 225,000
0 0 0
Form SSA-821-BK collects information that provides evidence necessary to determine initial or continuing eligibility for Supplemental Security Income or Social Security disability benefits. An individual's entitlement to benefits ends if he/she demonstrates an ability to perform substantial gainful activity (SGA). This form is used to determine whether work an individual performs in employment is at the SGA level. The respondents are Social Security disabiity applicants and beneficiaries and Supplemental Security Income applicants.
None
None
No
1
IC Title Form No. Form Name
Work Activity Report--Employee 20 CFR 404.1520(b), 404.1571-.1576, 404.1584-.1593 and 416.971-.976 SSA-821-BK
  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 300,000 300,000 0 0 0 0
Annual Time Burden (Hours) 225,000 225,000 0 0 0 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.
03/22/2006