SSA-821-BK 2012 free printable template

This list may not be complete. It may not show your work for this year or last year. You should add any additional work information as you complete the form. Employer Name Form SSA-821-BK 04-2012 ef 04-2012 Year Earnings For More Information Please read the enclosed pamphlet Working While Disabled. Reasons for Changes in Work Activity My physical and/or mental condition s work were removed Stopped working Other reasons please explain in 6B Reduced my work hours Reduced my earnings Changed to...

How to fill out SSA-821-BK

How to fill out SSA-821-BK

1. Obtain the SSA-821-BK form from the Social Security Administration (SSA) website or office.
2. Fill out your personal information such as name, address, and Social Security number at the top of the form.
3. In Section 1, provide information about the type of work you have done in the past 15 years.
4. In Section 2, provide details about your medical condition and how it affects your ability to work.
5. In Section 3, list any medications you are currently taking related to your condition.
6. Complete additional questions providing detailed descriptions of your limitations and abilities.
7. Review the entire form for accuracy and completeness.
8. Sign and date the form before submitting it to the SSA.

Who needs SSA-821-BK?

1. Individuals applying for Social Security Disability Insurance (SSDI) benefits who have a medical condition affecting their ability to work.
2. Anyone undergoing a Continuing Disability Review (CDR) to assess ongoing eligibility for disability benefits.

• Who needs an SSA-821-BK Form?
• What is Form SSA-821-BK, Work Activity Report for?
• Is Work Activity Report Form accompanied by other forms?
• • When is SSA Form 821-BK due?
  • How do I fill out Form SSA-821-BK?
  • Where do I send Work Activity Report Form?

Who needs an SSA-821-BK Form?

SSA-821-BK is the Social Security Administration Form; its full name is Work Activity Report — Employee. It is used by the SSA to process the information regarding any work performed SDI beneficiaries, who may have gained any earning for work activities after claiming disability.

What is Form SSA-821-BK, Work Activity Report for?

This Report aims to provide detailed information as for work activity that was performed after the alleged onset date. On the basis of the data provided in the report, the SSA will make a decision whether the beneficiary is still eligible for their disability benefits.

Is Work Activity Report Form accompanied by other forms?

Typically, there is no need to attach any other forms or documents to the SSA-821-BK form, unless it is clearly communicated by SSA. However, there is a provision requiring confirmation of any payments claimed on the form, therefore, attached pay stubs should support them.

When is SSA Form 821-BK due?

In case the form was sent by SSA, the completed properly report form should be returned to the SSA local office within 15 days from its receipt.

If it is the beneficiary’s initiative to file a form, it should be as soon as possible after any payments were received.

How do I fill out Form SSA-821-BK?

The completed form must explain the work activity or another type of income in all the details as demanded by the SSA.

Where do I send Work Activity Report Form?

After the Form SSA-821-BK is thoroughly filled out, it should be directed back to the office, which sent it to you.

Instructions and Help about SSA-821-BK

This is the work history report provided to claimants who have applied for Social Security disability benefits this form does come directly from the Social Security office it is not sent to you from your attorney it is sent to you from the Social Security office in order for them to gather all the information they need in order to make a decision on whether you qualify for disability benefits and if you will be awarded obviously the more work you have the more work credits you have which will affect the award amount we often have clients that ask us if they have to fill this out or how much of it they have to fill out do they really have to go back 15 years and the answer to those questions or yes to all of them you do need to fill this out your attorney cannot do this for you because you know your history the best however at least here at the Kali law firm where he'll be happy to help you walk you through the form and if you just physically cannot write or tie then of course we would help you with it if you don't have someone at home that can do it for you the first page section one just asks for your name social security number and daytime telephone number where you can be reached any time you need to put all this information in because this will associate it to your disability application section two is information about your work so the first portion it does asks to list all the jobs that you've had in the last 15 years you need to list everything that you've had what your job was what type of business it and the days that you work as close to as accurate as possible obviously 15 years ago it's hard to remember exact dates and that's fine don't worry about it just keep it as you know accurate as possible once you've listed just all your jobs and the next several pages each pages for each job and is asking for very specific information it's asking for your rate of pay whether it's hourly or salary how much you worked how many days per week that you worked and then a description of the job itself what did you do all day they're going to get a sense of just your type what type of work that you're qualified to do you were healthy and then ultimately based on this and then Medical has history and other things they'll be able to determine if you're able to continue doing this sort of job this is why you've hired an attorney we do the argument for you defense for you, but we do need you to fill out this information after you've given a description of the job you will just answer the remaining questions give them an idea of how often or how what the frequency of how much you did something like walking or standing were you on your feel a day did you have to crawl or crouched let's say you're someone that has a shoulder injury, and you can no longer lift things, but that's what all your work history is that's good supporting your case you want to make sure you give them accurate information of how much you lifted during your jobs again this section...

People Also Ask about

What is SSA 8001 form?

SSA-8001: Application for Supplemental Security Income (SSI) (Deferred or Abbreviated) The SSA-8001 is an abbreviated version of the SSA-8000: Application for Supplemental Security Income.

What is the SSA consent for release of information?

A Consent for Release of Information (SSA-3288) must be signed by each individual whose work history will be used to establish the 40 quarters of coverage information. However, a consent form is not needed when requesting information on a deceased individual's Social Security Number.

What is an SSA 821 form?

Social Security uses the Work Activity Report form to learn more about the work activity of a disability applicant or beneficiary. If you are applying for disability benefits, the information you provide will help us decide if you can receive benefits.

How to fill out SSA 821?

How do I fill out Form SSA-821-BK? Personal information about the insured disabled person; Name of wage earner in their family; Type of benefits received; Information about the work activity and earnings; Employment data; Special work conditions (if any); Any special payments and work expenses;

What is the SSA form for SSI application?

SSA-8000: Application for SSI. The SSA-8000: Application for Supplemental Security Income (SSI) is completed by an SSA claims representative either at a field office or on the phone. In some SOAR communities, case managers are trained to complete the SSA-8000 and submit the paper version to SSA.

Who fills out SSA 821 form?

The Social Security Administration (SSA) may ask the applicant to complete an SSA-821 Work Activity Report if he/she continued to work after the alleged date of onset. This article provides additional information and tips for assisting applicants with this form.

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What is SSA-821-BK?

SSA-821-BK is a form used by the Social Security Administration (SSA) to collect information about a person's work activity and earnings when they are applying for or receiving Social Security Disability benefits.

Who is required to file SSA-821-BK?

Individuals who are applying for Social Security Disability Insurance (SSDI) or those who are already receiving benefits and need to report their work activity must file SSA-821-BK.

How to fill out SSA-821-BK?

To fill out SSA-821-BK, applicants should provide their personal information, details of their work activity, any earnings, and other relevant information as requested on the form, ensuring that all sections are completed accurately.

What is the purpose of SSA-821-BK?

The purpose of SSA-821-BK is to evaluate whether a person's work activity affects their eligibility for disability benefits and to determine the amount of benefits they may receive.

What information must be reported on SSA-821-BK?

The SSA-821-BK requires reporting of personal identification information, employment details, the nature of work performed, hours worked, and earnings for the specified period.