Work Activity Report - Form SSA-821-BK

How to Obtain the Form

Below you will this form in Portable Document Format (PDF). To print the PDF version, you will need the Adobe Acrobat reader software. If you do not already have this special software, you can download and install it for free at the Adobe website.

PDF files are printer independent using any printer. If you are using the software to view SSA forms, the form should be printed on 8 1/2" x 11" white paper. You must print the form with blue or black ink to be acceptable to SSA.

If you need further information, Customer Support is available at Adobe's website.

Please do not contact the Social Security Administration for problems or questions concerning the Adobe Reader software.

After you download the Adobe Acrobat Reader, come back to this page and download the PDF version of the SSA-821-BK:

SSA-821 in

How to Complete the Form

The claimant, beneficiary, or his or her representative completes items 1 through 10 in Part II. We consider the SSA-821-BK to be a self-help form.

Where To Send The Form

Print the PDF SSA-821-BK on 8 ½ x 11 inch paper, complete and sign the form, and mail it to your local Social Security office. If you are not sure where your local office is located, try our Social Security Office Locator service or call 1-800-772-1213.


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