TN 8 (02-12)
DI 10510.025 Documenting Self-Employment Cases Using the SSA-820-BK (Work Activity Report-Self-Employment) and the SSA-823 (Report of SGA Determination- For SSA Use Only)
The field office (FO) and processing center (PC) use the SSA-820-BK (Work Activity Report Self-Employment) to resolve work issues, and to determine if any work incentives apply prior to making a substantial gainful activity (SGA) determination.
The SSA-820-BK is a self-help form that the claimant, beneficiary, or representative completes; however, depending on individual case circumstances, we offer assistance in completing the form.
A. When to use the SSA-820-BK
Use the SSA-820-BK (Work Activity Report-Self-Employment) to document self-employment activities and income for both initial claims, and continuing disability review (CDR) cases
NOTE: To document the SGA decision, use the SSA-823 (Report of SGA Determination – For SSA Use Only).
B. When you must complete the SSA-820-BK
It is especially important to assist with the development and documentation of self-employment cases whenever possible because of the varied and complex situations that can occur.
Use careful judgment when determining the claimant’s or beneficiary’s ability to understand and complete the form:
If you have difficulty obtaining the required information during a telephone interview, schedule an in-person interview as soon as possible.
In other situations, give or mail the appropriate form for completion..
When you mail or give the SSA-820-BK to the beneficiary or claimant, be sure to include the “Working While Disabled” publication.
See also: For interviewing techniques in disability claims, see GN 00203.002, Pre-Application Actions For Interviewing Claimants, see GN 00203.003, Face- to- Face Contact with Claimants).
C. Complete the SSA-820-BK
Follow these steps:
Complete the SSA-820-BK for work CDR cases, and for initial application cases involving self-employment, when self-employment occurs under the following conditions:
after the alleged onset date;
after the date the claimant alleges his or her impairment(s) first began to interfere with his or her ability to work;
after the controlling date in disabled widow(er)'s benefit (DWB) claims;
any time in childhood disability benefit (CDB) claims;
after the filing date in supplemental security income (SSI) claims;
after age 55 in certain blindness claims;
under sheltered conditions; or
when work that may represent an unsuccessful work attempt (UWA).
Complete the SSA-820-BK in initial application cases if any of the bulleted conditions in DI 11005.045B.2.b (or if alleging work above the SGA amount in section 4.E or 4.G on the SSA-3368 (Adult Disability and Work History Report) or the equivalent questions on the EDCS 3368 illnesses and onset screens) apply.
If there are multiple instances of self-employment that differ substantially from period to period, use separate forms, when necessary. Use the SSA-821-BK (Work Activity Report - Employee) in work and employee cases (for more information on the SSA-821-BK, see DI 10505.035).
D. How to access and store the SSA-820-BK
1. Initial claims for certified electronic folder (CEF) cases
Follow these steps:
Access the SSA-820-BK through eForms in the electronic disability collect system (EDCS) or eWork, and then use the following instructions to process CEF cases:
Complete the SSA-820-BK, per DI 10510.025E in this section, using form attestation; and
Upload the SSA-820-BK into the CEF via EDCS at the point of intake; or
Prepare the SSA-820-BK in eWork and fax the completed form into the CEF.
Check eView to make sure the form is legible.
If you are unable to complete the SSA-820-BK during the initial interview, and you received the form after you transferred the case to the Disability Determination Service (DDS),
fax the completed form using the appropriate barcode into the CEF, and
check eView for legibility.
2. Initial claims for CEF exclusion and limitation cases
Any claim excluded from electronic processing results in a paper folder. If you are creating an SSA-820-BK for a CEF exclusion or limitation case:
Follow the instructions in DI 10510.025D.1 in this section, to access, prepare, and store the SSA-820-BK. Print the SSA-820-BK and insert it into the Disability Related Development and Documentation (Blue) section of the Modular Disability Folder (MDF).
The paper folder becomes the official folder, all information associated with the claim, print and place in the paper folder.
NOTE: It is extremely important that the SSA-820-BK and any related documents are available to the DDS.
Before transferring any case to the DDS, always check the certified claims file record management system (CFRMS) for any SSA-820-BK and related documents that have not alreadybeen stored in the paper folder.
If there are CFRMS forms that are not in the paper folder, print those documents and place them in the paper folder prior to forwarding to the DDS.
3. Post-entitlement (PE) cases
Follow these steps:
Prepare the SSA-820-BK in eWork for all work CDR cases.
For CEF cases, fax the form into eView, and make sure the form is legible.
For non-CEF cases, print the form and place it in the MDF. In addition, fax the form into the Non-Disability Repository for Evidentiary Documents (NDRed), per GN 00301.322.
Receipt in the eWork issue when resolved.
E. How to complete the SSA-820-BK
1. Section: Identification-To Be Completed by SSA
Complete as follows:
Show name(s) and SSN(s) in the appropriate boxes.
Check appropriate “Blind or Not Blind” box.
Show claim number and beneficiary identification code (BIC)
Insert appropriate work development date (i.e., alleged onset date, date of onset, date of entitlement, or last determination date).
2. Section: Information To Be Completed By Person Applying For Or Receiving Benefits
Check whether there was self-employment income, but no self-employment work activity, since the date in the identification section. If “no” is checked, question 2 must be answered, otherwise, skip to question 3.
This question captures information about income that does not represent self-employment work activity. Complete what the payment was for, the name and address of the payer, the amount, or estimate of the payment, and when the claimant or beneficiary received the payment. Skip to question 9.
Complete self-employment business information, and check the type of ownership arrangement. If the claimant or beneficiary has a farm arrangement, see instructions in this section, DI 10510.025G.
In SGA determinations, this question captures information about management services. If a self-employed individual is rendering management services for more than 45 hours per month, we may determine a finding of SGA. Show each month, the net earnings, and check if the claimant or beneficiary worked more than 45 hours a month. Evaluate this section by referring to DI 10510.015, Test One of the General Evaluation Criteria-Significant Services and Substantial Income.
NOTE: If you are making a trial work period (TWP) determination, 80 hours constitutes a TWP service month (see DI 13010.060).
The claimant or beneficiary may choose to attach his or her tax return, rather than completing the chart. If income tax returns are not attached, follow instructions in this section, DI 10510.025F.
After Question 5, you can curtail development if the beneficiary or if claimant is blind, and any earnings after onset (or after the date of the prior CDR) do not exceed the SGA guidelines for the blind (for SGA amounts, refer to DI 10501.015). If you curtail development, write, “Development curtailed, per DI 10515.005.” You may also curtail development if the beneficiary has received benefits for more than 24 months at the time he or she earned the self-employment income. Write, “Development curtailed per DI 10510.010”.
Show the extent that the claimant or beneficiary executed management responsibilities. For more information on significant services, see DI 10510.015B.
Identify the effect that the disability has on the claimant or beneficiary’s ability to perform his or her duties, and what additional assistance is required because of the disability. Be aware of UWAs. For more information on UWAs, see DI 10501.055.
Identify possible unpaid help or un-incurred business expenses deductions. We can deduct the value of donated business items, such as rent-free space, heat, utilities, or services from gross earnings in determining countable income. For more information on unpaid help and un-incurred business expenses, see DI 10510.012.
Collect information on impairment-related work expenses (IRWE). These items or services are required for the self-employed claimant or beneficiary to work. For more information on IRWE, see DI 10520.001.
3. Section: Remarks
Document any additional information that the claimant or beneficiary did not have space for in other parts of the form. Do not use this section to document your SGA rationale.
4. Section: Signature
Signature proxy applies to the SSA-820-BK when you take an initial claim. If you are completing the form for a CDR, you must obtain a wet signature. For more information on alternative signature requirements, see GN 00201.015, Alternative Signature Methods. If a third party refuses to sign, document the form with “Refused to sign.” Also note the source of the information, and if possible, the reason for the refusal.
F. Documenting allegations and obtaining corroborative evidence
It is essential that the evidence includes not only what the claimant’s or beneficiary’s activities have been since the alleged date of disability onset, but also how the activities compare with those he or she performed before that date.
Explain discrepancies between allegations as a reduction in services, this explanation should support the need of the business for services of that type.
Document an alleged decline in the claimant’s or beneficiary’s activities after the alleged onset date, and how this decline affected the business. Make every attempt to obtain a clear explanation regarding how he or she modified services after the alleged date of onset.
Obtain corroboration whenever there is any indication that the claimant or beneficiary may not be giving a full and accurate statement about the business (i.e., either because of lack of knowledge, inability to communicate).
Corroborative evidence should include income tax returns, statements by customers, employees, sales clerks, suppliers, and others having dealings with the business, as well as your own direct observation of business activities and conditions.
G. Coordination of coverage and SGA development in farm cases
The information given on the SSA-7156 (Farm Self-Employment Questionnaire) and SSA-7157-F4 (Farm Arrangement Questionnaire), obtained in the development of earnings and coverage, is pertinent to an SGA determination. This form also collects a thorough explanation on the experience, education, and training of the claimant or beneficiary. For more information on the SSA-7156, see RS 01804.200.
Since your goal is to supplement the information obtained in connection with development of coverage and earnings, you will not always need to complete Section 5 of the SSA-3368-BK (Disability Report) or Section 2 of the SSA-3369-BK (Work History Report) a SSA-821-BK (Work Activity Report - Employee) or SSA-820-BK (Work Activity Report - Self-Employed Person).
When the situation described on the SSA-7156 (Farm Self-Employment Questionnaire) and SSA-7157-F4 (Farm Arrangement Questionnaire) has changed due to the impairment, include a supplementary report, and give a detailed account of all the factors involved in the change.
H. Controlling the return of the SSA-820-BK
For managing controls, follow the same instructions as you would for the SSA-821-BK, in DI 10505.035.
I. When you must complete the SSA-823 (Report of SGA Determination-For SSA Use Only)
Complete the SSA-823 in all initial claim determinations. In post- entitlement (PE) situations, you may complete the form to document your rationale for unusual circumstances, or to document your rationale in self-employment cases that require you to use the three tests under the general evaluation criteria. In most cases, completion of the form is optional if you are using eWork to process your decision. However, if you cannot use eWork to process your decision, you must complete the SSA-823. For instructions on how to complete the SSA-823, see DI 10505.035.
J. Related references
DI 10505.000 Evaluation and Development of Employment - Table of Contents
DI 10510.010 SGA Criteria in Self-Employment
DI 13010.025 FO Responsibilities in Work Issue CDRs
DI 81010.030 Certified Electronic Folder (CEF) Exclusions and Limitations
DI 81010.090 Faxing Documents into the Certified Electronic Folder (CEF) Using Barcodes
DI 81010.095 Using the Update-After-Transfer (UAT) Utility
DI 81010.120 Using Form Attestation for Work Activity Reports
DI 81010.140 Processing Field Office (FO) Determinations
GN 00201.015 Alternative Signature Methods
OS 15025.010 SSA-821-BK Work Activity Report-Employee