SSA-821-BK 2012 free printable template

Social Security Administration Retirement, Survivors, and Disability Insurance Important Information Date: Claim Number: Phone:

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's website or local office.
2. Start by filling in your personal information at the top of the form, including your name, Social Security number, and contact information.
3. Provide detailed information about your medical conditions, including dates of diagnosis and treatment.
4. List any medications you are currently taking and the names of your healthcare providers, along with their contact information.
5. Answer the questions regarding your ability to work, focusing on any limitations caused by your medical condition.
6. Review the form for completeness, ensuring all sections are filled out accurately.
7. Sign and date the form before submitting it to the appropriate Social Security office.

Who needs SSA-821-BK?

1. Individuals applying for Social Security Disability benefits who are required to report their medical conditions and how they affect their ability to work.

• 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 a 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.

What form do I need to fill out for Social Security benefits?

Form SSA-1 | Information You Need To Apply For Retirement Benefits Or Medicare. You can apply: Online; or. By calling our national toll-free service at 1-800-772-1213 (TTY 1-800-325-0778) or visiting your local Social Security office.

How long does it take to start receiving Social Security benefits after applying?

Benefit applications can take up to three months to process, so apply three months before your planned start date. If you are drawing spousal or survivor benefits on another person's earnings record, your payment date depends on that person's birthday and follows the schedule above.

How do I get the $16728 Social Security bonus?

To acquire the full amount, you need to maximize your working life and begin collecting your check until age 70. Another way to maximize your check is by asking for a raise every two or three years. Moving companies throughout your career is another way to prove your worth, and generate more money.

How to complete SSA 821 BK?

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;

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What is SSA-821-BK?

The SSA-821-BK is a form used by the Social Security Administration (SSA) to collect information regarding a person's disability and work history for the purpose of making decisions on benefits.

Who is required to file SSA-821-BK?

Individuals who are applying for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) benefits may be required to file the SSA-821-BK as part of their application process.

How to fill out SSA-821-BK?

To fill out the SSA-821-BK, applicants need to provide detailed information about their work history, medical conditions, and any relevant medical treatment. It's recommended to follow the form's instructions carefully and gather all necessary documentation prior to filling it out.

What is the purpose of SSA-821-BK?

The purpose of the SSA-821-BK is to assist the SSA in assessing an applicant's disability status and determining eligibility for benefits based on their work history and medical impairments.

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

The SSA-821-BK requires information regarding the applicant's work history, detailed descriptions of their medical conditions, treatments received, and how these conditions affect their ability to work.