This online service allows you to electronically complete, sign, and submit the Work Activity Report – Employee (Form SSA-821). You may use this online service as an alternative to completing a paper version of this form. To complete the form online, you will need a valid email address.
PRIOR TO USING THIS OPTION, YOU MAY HAVE RECEIVED A REQUEST TO COMPLETE A WORK ACTIVITY REPORT – EMPLOYEE (FORM SSA-821) FROM SOCIAL SECURITY.
Before beginning the form, you will enter and confirm your email address in the online application.
You will receive an email from firstname.lastname@example.org containing a link and instructions on how to access the form. The link will expire after fifteen (15) calendar days. If the link expires, you will need to return to this page to request a new link.
IMPORTANT: We will not process the form until you complete the form, sign the form electronically, and select “Click to Sign” to submit the form. Upon submission, you will be able to download a copy of the signed form within the application. We recommend that you save a copy for your records. You will receive an email confirming your submission.
Sections 223(d) and 1633 of the Social Security Act, as amended, allow us to collect this information. Furnishing us this information is voluntary. However, failing to provide all or part of the information may prevent an accurate and timely decision on any claim filed or could result in an overpayment of benefits.
We will use the information to make a determination of eligibility for benefits. We may also share your information for the following purposes, called routine uses:
In addition, we may share this information in accordance with the Privacy Act and other Federal laws. For example, where authorized, we may use and disclose this information in computer matching programs, in which our records are compared with other records to establish or verify a person's eligibility for Federal benefit programs and for repayment of incorrect or delinquent debts under these programs.
A list of additional routine uses is available in our Privacy Act System of Records Notices (SORN) 60-0059, entitled Earnings Recording and Self-Employment Income System, as published in the Federal Register (FR) on January 11, 2006, at 71 FR 1819, 60-0320, entitled Electronic Disability Claim File, as published in the FR on June 4, 2020, at 85 FR 34477; and 60-0330, entitled eWork, as published in the FR on September 15, 2003, at 68 FR 54037. Additional information, and a full listing of all our SORNs, is available on our website at www.ssa.gov/privacy .