New Work Activity Report (SSA-821-BK) form
Link to new Work Activity Report form HEREEffective Dates: 09/09/2025 - Present
Identification Number: EM-25054
Intended Audience: All RCs/ARCs/ADs/FOs/TSCs/PSCs/OCO/OCO-CSTs/OHO/OARO
Originating Office: ORDP ODP
Title: Updates to Form SSA-821-BK
Type: EM - Emergency Messages
Program: Title XVI (SSI); Disability
Link To Reference: See Reference at the end of this EM.
Retention Date: 03/09/2026
A. Purpose
This EM is to inform you about updates to form SSA-821-BK (Work Activity Report) You can access
the new SSA-821-BK via inForms. The form will be available in UniForms in December 2025.
B. Background
We received feedback from advocates and technicians stating that form SSA-821-BK is too long and
complicated and that this prevents applicants and beneficiaries from fully completing and in many
cases returning the form. To address these concerns, we updated and streamlined the form. We
clarified why we are asking for information and how providing it may help the applicant or
beneficiary. We updated certain fields to make it compatible with the Upload Docs workflow.
C. Policy
Technicians use the form SSA-821-BK to document work activity and work incentives prior to
making a substantial gainful activity (SGA) determination for initial claims, appeals, expedited
reinstatement, and work continuing disability review (CDR) cases.
D. Changes to Form SSA-821-BK
Social Security
Emergency Message
9/10/25, 10:31 AM PolicyNet/Instructions Updates/EM-25054: Updates to Form SSA-821-BK
https://secure.ssa.gov/apps10/reference.nsf/lnx/09092025023213PM?opendocument=&utm_medium=email&utm_source=govdelivery 1/3
Below is a list of some of the changes to the form along with a brief explanation of the change.
1. Cover letter
· Removed the prefilled “Please tell us about your work since” sentence to be
compatible with Upload Docs. Technicians may prefill the date on page 3, when
appropriate. If the date is not prefilled, we request the information covering the past
two years. Individuals may receive a blank form, for instance, Upload Docs does
not support prefilled form information.
· Added the types of information requested, the reasons for requesting it, how the
information will be used, and a definition of work incentives.
· Removed the table with prefilled IRS data. More recent earnings information is
typically available and can be displayed in the “Employment Information” Section.
2. Employee Identification Section
· Added the option “or SSN” for when the form is completed by the applicant or
beneficiary.
3. Income Information Section
· Question 2
Ø Removed the table of income types and added NO, YES check
boxes.
Ø Added a rationale for why SSA needs this information.
Ø Added a remarks section and removed the general remarks at the
end of the form.
· Question 3
Ø Added “Reason Work Ended (if applicable)” with the choices of
“Because of my disability” or “Other reason(s)” to aide in Unsuccessful
Work Attempt (UWA) development.
Ø Removed the ‘Pay Stub Table’ from each employment information
iteration and added a check box indicator if pay stubs are provided. We
now have various earnings data sources to obtain wage data (Payroll
Information Exchange etc.). Completing the ‘Pay Stub Table’ with
estimates is error prone and many beneficiaries skipped this section or
stopped completing the form altogether when they reach this section.
· Question 4
Ø Updated with an example and explanation why we are asking for
this information. Many did not understand why we are asking for this
information and, therefore, would not complete this section.
4. Work Incentives Information Section
· Question 5 (subsidies and special conditions)
9/10/25, 10:31 AM PolicyNet/Instructions Updates/EM-25054: Updates to Form SSA-821-BK
https://secure.ssa.gov/apps10/reference.nsf/lnx/09092025023213PM?opendocument=&utm_medium=email&utm_source=govdelivery 2/3
Ø Removed the information gathering table and added Questions 5B
and 5C.
Ø Added four check box choices to 5B explaining possible
accommodations and space to provide information about the employer
providing the accommodation to each choice.
Ø Added “someone other than your employer” (with examples) to 5C
to mimic the “knowledgeable source[s]” listed on Form SSA-3033.
· In Question 6 (UWA)
Ø Changed the wording of this question to clarify why we are asking
for this information and how providing it may help them.
Ø Added the yes and no format to negate the need for a negative
reply later in the question.
· Question 7 (Impairment Related Work Expenses)
Ø Clarified why we are asking for this information and how providing it
may help the applicant/beneficiary.
Ø Added language clarifying possible reimbursement choices for the
expense will reduce pre-completion contact or the collection of
misinformation. We added a ‘Continuing’ cost indicator to tell us about
reoccurring expenses.
Direct all program-related and technical questions to your Regional Office (RO) support staff or
Program Service Center (PSC) Operations Analysis (OA) staff. RO support staff or PSC OA staff
may refer questions, concerns or problems to their Central Office contacts.
Reference:
DI 10505.035 Documenting Employment Cases Using Forms SSA-821-BK (Work Activity-
Employee) and SSA-823 (Report of SGA Determination – For SSA Use Only)
DI 10505.005 Determining and Verifying Gross Earnings from Employment