Employee Work Activity Questionnaire

Social Security Disability Insurance (SSDI) beneficiaries and Supplemental Security Income (SSI) recipients qualify for payments when a verified physical or mental impairment prevents them from working. If disability claimants attempt to return to work after receiving payments, but are unable to continue working, they submit Form SSA-3033, Employee Work Activity Questionnaire, so SSA can evaluate their work attempt. SSA also uses this form to evaluate unsuccessful subsidy work and determine SSDI and SSI applicants’ continuing eligibility for disability payments. The respondents are employers of SSDI beneficiaries and SSI recipients who unsuccessfully attempted to return to work. We are adding the beneficiary's Social Security Number (SSN) on every page of Form SSA-3033.

The latest form for Employee Work Activity Questionnaire expires 2021-01-31 and can be found here.