View Information Collection Request (ICR) Package
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Please note that the OMB number and expiration date may not have been determined when this Information Collection Request and associated Information Collection forms were submitted to OMB. The approved OMB number and expiration date may be found by clicking on the Notice of Action link below.
View ICR - OIRA Conclusion
OMB Control No:
0960-0059
ICR Reference No:
202409-0960-008
Status:
Active
Previous ICR Reference No:
202111-0960-004
Agency/Subagency:
SSA
Agency Tracking No:
Title:
Work Activity Report--Employee
Type of Information Collection:
Revision of a currently approved collection
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Approved without change
Conclusion Date:
07/24/2025
Retrieve Notice of Action (NOA)
Date Received in OIRA:
12/16/2024
Terms of Clearance:
The agency will conduct a non-substantive change to update this information collection after the revised form is issued. In addition, the agency will provide timely update to OMB regarding any concerns raised by claimants, SSA personnel, or advocates regarding how the removal of income information or other supplemental information historically provisioned by SSA has impacted the burden or quality of submissions.
Inventory as of this Action
Requested
Previously Approved
Expiration Date
07/31/2028
36 Months From Approved
07/31/2025
Responses
411,300
0
411,300
Time Burden (Hours)
445,610
0
205,650
Cost Burden (Dollars)
0
0
0
Abstract:
SSA uses Form SSA-821-BK to collect employment information to determine whether individuals have worked after becoming disabled and, if so, whether the work is SGA. We use the information to make a determination of eligibility for disability payments. Specifically, we use Form SSA-821-BK to obtain information from individuals during the initial SSI and SSDI claims process; the Continuing Disability Review (CDR) process; and appeals involving work issues. An SSA employee may fill out the form during an in office or telephone interview, or the applicants or recipients may fill it out themselves. SSA reviews and evaluates the data to determine if the applicant or recipient meets the disability requirements of the law. If respondents work when they apply for benefits, they must complete this collection to obtain SSI or SSDI. The respondents are SSDI applicants or recipients, and SSI applicants.
Authorizing Statute(s):
US Code:
42 USC 423
Name of Law: Social Security Act
US Code:
42 USC 1383b
Name of Law: Social Security Act
Citations for New Statutory Requirements:
None
Associated Rulemaking Information
RIN:
Stage of Rulemaking:
Federal Register Citation:
Date:
Not associated with rulemaking
Federal Register Notices & Comments
60-day Notice:
Federal Register Citation:
Citation Date:
89 FR 74351
09/12/2024
30-day Notice:
Federal Register Citation:
Citation Date:
89 FR 97155
12/06/2024
Did the Agency receive public comments on this ICR?
No
Number of Information Collection (IC) in this ICR:
4
IC Title
Form No.
Form Name
SSA-821-BK - Electronic
SSA-821-APP
Work Activity Report – Employee
SSA-821-BK - In Office Responses
SSA-821-BK
Work Activity Report – Employee
SSA-821-BK - Returned Via Mail
SSA-821-BK
Work Activity Report – Employee
SSA-821-BK - Telephone Interview
SSA-821-BK
Work Activity Report – Employee
ICR Summary of Burden
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
411,300
411,300
0
0
0
0
Annual Time Burden (Hours)
445,610
205,650
0
0
239,960
0
Annual Cost Burden (Dollars)
0
0
0
0
0
0
Burden increases because of Program Change due to Agency Discretion:
No
Burden Increase Due to:
Burden decreases because of Program Change due to Agency Discretion:
No
Burden Reduction Due to:
Short Statement:
When we last cleared this information request in 2021, the burden was 205,650 hours. However, we are currently reporting a burden of 244,145 hours. This change stems from an increase in the average burden per response. We last reported an average burden of 30 minutes, but now are adding categories of response with burdens of 40 and 45 minutes. Although the average burden per response changed, SSA did not take any actions to cause this change. These figures represent current Management Information data. * Note: The total burden reflected in ROCIS is 445,610, while the burden cited in #12 of the Supporting Statement is 244,145. This discrepancy is because the ROCIS burden reflects the following components: field office waiting time + a rough estimate of a 30-minute, one-way, drive burden + learning costs. In contrast, the chart in #12 of the Supporting Statement reflects actual burden.
Annual Cost to Federal Government:
$4,742,493
Does this IC contain surveys, censuses, or employ statistical methods?
No
Does this ICR request any personally identifiable information (see
OMB Circular No. A-130
for an explanation of this term)? Please consult with your agency's privacy program when making this determination.
Yes
Does this ICR include a form that requires a Privacy Act Statement (see
5 U.S.C. §552a(e)(3)
)? Please consult with your agency's privacy program when making this determination.
Yes
Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]?
No
Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]?
No
Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)?
No
Is this ICR related to the Pandemic Response?
No
Agency Contact:
Faye Lipsky 410 965-8783 faye.lipsky@ssa.gov
Common Form ICR:
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:
(a) It is necessary for the proper performance of agency functions;
(b) It avoids unnecessary duplication;
(c) It reduces burden on small entities;
(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;
(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;
(f) It indicates the retention periods for recordkeeping requirements;
(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:
(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;
(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.
(i) It uses effective and efficient statistical survey methodology (if applicable); and
(j) It makes appropriate use of information technology.
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.
Certification Date:
12/16/2024
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