Addendum to the Supporting Statement

ADDENDUM TO THE SUPPORTING STATEMENT for Form SSA-821-BK

Work Activity Report (Employed Person)

OMB No. 0960-0059

Minor Revisions to the Collection Instrument

In 2010, the Office of Operations raised safety concerns, citing the escalating number of threats and hostile actions directed toward SSA officials whose names appear on denial or adverse actions notices. SSA believes we may be exposing employees to negative or harmful attention from the public by continuing to provide the name of management on notices. To mitigate this risk, the Commissioner replaced the name and title of the official, with a general legend of “Social Security Administration.” Therefore, we are requesting approval of this non-substantive change now, rather than waiting until the next clearance process.

We are requesting a change to the signature on the cover letter on the SSA-821-BK. Currently we list the name and title of the field office or processing center management official. Due to a change in operational procedure, we will no longer include the management official’s name or title. We now write: Social Security Administration, in script font as the signature. We will implement this change upon OMB approval.

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 The current language, which dates back to the last reprint of the form, is now outdated.