Addendum - 0059

Addendum to the Supporting Statement for Form SSA-821-BK

Work Activity Report – Employee

20 CFR 404.1520(b), 404.1571-404.1576,

404.1584-404.1593, and 416.971-416.976

OMB No. 0960-0059

Revisions to the Collection Instrument

SSA is making the following revisions:

• Change #1: We are revising the first paragraph language of the cover letter on Page 1 of 12.

Current Language: We are writing to you because we need to know more about your work. Please tell us about your work since __________________. We will use this information to decide if you can receive or continue to receive disability benefits.

Revised Language: We are writing to you because we believe you may have recent work activity and we need to know more about this work activity.  Please tell us about your work since __________________.  If you are applying for disability benefits, the information you provide will help us decide if you can receive benefits. If you are currently receiving disability benefits, the information you provide helps us decide if you can continue to receive benefits.

Justification #1: We are revising this paragraph per the Office of Management and Budget’s (OMB) request to explicitly state the two scenarios—initial claim eligibility and post‑entitlement eligibility review—in which SSA is collecting the information for.

• Change #2: We are revising the PRA statement on this form.

Justification #2: We are revising the PRA statement to reflect our current boilerplate language.  The current language, which dates back to the last reprint of the form, is now outdated.

• Change #3: We are revising the Privacy Act Statement on this form.

Justification #3: SSA’s Office of the General Counsel is conducting a systematic review of SSA’s Privacy Act Statements on agency forms. As a result, SSA is updating the Privacy Act Statement on this form.