Social Security Forms

Form SSA-821-BK

Work Activity Report

How to Obtain the Form

Below you will find 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, see our page on downloading and printing PDF documents.

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 or his/her representative completes items 1 through 10 in Part II. The SSA-821-BK is considered to be a self-help form.

Send the 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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