Addendum to Supporting Statement

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:  On the Cover letter, first page: Replaced “Claim Number:” with Beneficiary Notice Control number (“BNC#:”);

Justification #1:  On September 15, 2017, the President signed into law H.R. 624, the Social Security Number Fraud Prevention Act of 2017, which became Public Law No. 115-59. The Senate passed the bill on September 6, 2017, by unanimous consent. The law, among other things, restricts the inclusion of Social Security Numbers (SSNs) on documents sent by mail by the Federal Government. We updated the form to comply with the new law to reflect “BNC#:”.

• Change #2:  On the Cover letter, second page under the Universal Text Identifier (UTI) caption, “For More Information,” first paragraph, first sentence: We corrected the name of the pamphlet to reflect: “Working While Disabled: How We Can Help.”

Justification #2: The previous language read “Working While Disabled ... How We Can Help.” We updated it to correct the discrepancy.

• Change #3:  On the Cover letter, second page, under “For More Information” paragraph, we added the below fraud language:

Suspect Social Security Fraud?

If you suspect Social Security fraud, please visit http://oig.ssa.gov/report

or call the Inspector General's Fraud Hotline at 1-800-269-0271 (TTY 1-866-501-2101).

Justification #3: The prior version of the form did not reflect our current fraud language. The fraud language reflects the current URL the agency is using for reporting fraud.

• Change #4: On Pages 4-5, Sections 3A, 3B, 3C and on pages 11-12. We changed the following information:
  
  From:

Area Code and Telephone Number

Area Code and Fax Number

To:

           

Supervisor’s Name

Supervisor’s Telephone Number (Include area code)

Justification #4:

We added a section for the supervisor’s telephone number because often it is different from the telephone number for the employer in general. The recipient will have the opportunity to provide us a direct line to the supervisor, rather than having to go through several different channels to obtain outstanding information about subsidies, special conditions, etc.

• Change #5: We are revising the Privacy Act Statement on this form.

Justification #5: 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 the form.

SSA will implement the changes above upon OMB approval.

These actions do not affect the public reporting burden.