Change for Work Activity Report (Employee) SSA-821-BK

1. Justification for Non-Substantive Change for Work Activity Report (Employee)

2. SSA-821-BK

OMB No. 0960-0059

Change 1: We are moving the last paragraph on page 2 of the cover letter to the top of page 2 of the cover letter, and inserting a subtitle for the paragraph.

Justification 1: We moved this information for organizational purposes, and to follow NL 00610.060, Notice Guidelines.

Change 2: We are changing the language in the first bullet under the subtitle on page 2 of the cover letter “If You Have Questions

• Current Language:

Visit us online at www. socialsecurity.gov. We can answer many of your general questions online.

• New Language:

Visit our website at www.socialsecurity.gov to find general information about Social Security.

Justification 2: We are making this language change for simplification purposes.

Change 3: We are changing the language in bullet two on page 2 of the cover letter.

• Current Language

Call us toll-free at 1-800-772-1213, or call your local field office at. If you are deaf or hearing impaired, our TTY toll-free number is 1-800-325-0778. We can answer most of your questions over the phone.

• New Language

Call us toll-free at 1-800-772-1213 or call your local office at 555-123-4567. You may also call your Social Security contact, John Smith, at 555-000-0000. We can answer most questions over the phone.

Justification 3: We are making the language change to provide beneficiaries with a contact name. We moved “If you are deaf or hearing impaired.” to a separate for organizational purposes.

Change 4: We added a fourth bullet to page 2 of the cover letter, and wrote: “If you are deaf or hard of hearing, our toll-free TTY number is 1-800-325-0778.”

Justification 4: We added this bulleted information for organizational purposes, and changed the language to be sensitive to deaf beneficiaries.

Change 5: We added a bullet to the second paragraph on page 2 of the cover letter, “If you live outside of the United States…”We will not print this address from the eWork system if the individual lives in the United States.

Justification 5: We added a bullet to this paragraph for organizational purposes, and to adhere to our plain writing initiatives. We only want to provide the contact information that is applicable to the individual who receives the form.

Change 6: We are changing the language in the fourth paragraph on page 2 of the cover letter.

• Current Language

If you do call or visit an office, please have this letter with you. It will help us answer your questions. Also, if you plan to visit an office, please call ahead to make an appointment. This will help us serve you more quickly.

• New Language:

Please have this letter with you if you call or visit an office. If you write, please include a copy of this letter. It will help us answer your questions.

Justification 6: We are making the language change for simplification and plain writing

purposes.

Change 7: The eWork system and the eForm system will not display the words “FO Address,” when we print the form, on page 1 of the cover letter.

Justification 7: We write the FO address on the paper version to show employees that field to insert the FO Address.

Change 8: We are changing the format for the Date Work Started and Date Work Ended fields in question 3 and the Date fields in the table in question 6A from (MM/YYYY) to (MM/DD/YYYY).

Justification 8: We are changing the format of these questions because we need the full date to accurately document entitlement for disability benefits.

Change 09: We will add two additional employer information pages that will follow the Privacy and Paperwork Reduction Acts.

Justification 09: We added these additional pages to provide our technicians and the public with additional room to add more employers, when necessary.

Change 10: We are inserting a first paragraph with four options on page 1 of the cover letter, when the beneficiary is blind. The language choices are:

• We are sending you this letter in both a standard print version and on a compact disc in Microsoft Word format. You will receive them in separate envelopes.

• We are sending you this letter in both a standard print version and on an audio compact disc. You will receive them in separate envelopes.

• We are sending you this letter in both a standard print version and in a Braille version. You will receive them in separate envelopes.

• We are sending you this letter in both a standard print version and a large print version. You will receive them in separate envelopes.

Justification 10: This is a mandate procedure that we applied to the eWork application to accommodate visually impaired individuals.

Change 11: When we send a final request for this form, the eWork system will generate a final notice on page 2 of the cover letter, under What You Need to Do section. This language will only generate when we use the eWork system.

• New Language

We are sending you another copy of the form. Please complete and return the completed form within 15 days to the address shown above.  It is important to fill out the form carefully and completely. Remember to sign and date the form. If you do not return this form, we may contact your employer or make our determination based on the evidence we have in our records.

Justification 11: We are adding this paragraph to show the beneficiary that they received a copy, and that we can make a determination based on our evidence if he or she does not respond to this final request.