Work Activity Report--Employee

SSA will insert the following revised Privacy Act & PRA Statements into the
form as soon as possible:
Privacy Act Statement
Collection and Use of Personal Information

Sections 223(d) and 1633 of the Social Security Act allows 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:
•

To employers, current or former, for correcting or reconstructing earnings records and for
Social Security tax purposes; and

•

To private medical and vocational consultants, for use in preparing for, or evaluating the
results of, consultative medical examinations or vocational assessments which they were
engaged to perform by SSA or a State agency, in accordance with sections 221 or 1633 of
the Social Security Act.

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, and 60-0320, entitled
Electronic Disability (eDIB) Claim File, as published in the FR on June 4, 2020, at 85 FR 34477.
Additional information, and a full listing of all our SORNs, is available on our website at
www.ssa.gov/privacy.

Paperwork Reduction Act Statement - This information collection meets the requirements of
44 U.S.C. § 3507, as amended by section 2 of the Paperwork Reduction Act of 1995. You do not
need to answer these questions unless we display a valid Office of Management and Budget
(OMB) control number. We estimate that it will take about 40 minutes to read the instructions,
gather the facts, and answer the questions. Send only comments regarding this burden estimate
or any other aspect of this collection, including suggestions for reducing this burden to: SSA,
6401 Security Blvd, Baltimore, MD 21235-6401.