Form SSA-3033 at a glance
What it is: Form SSA-3033 (01-2026) is the Work Activity Questionnaire of the Social Security Administration.
Where and when to file: The Social Security Administration would appreciate it if you would complete and return the questionnaire within 15 days.
Please have someone, other than the employee, with direct knowledge of the employee's work activity complete the work activity questionnaire.
This could be a supervisor or the employee's employment service provider, such as a job coach, job developer, or other knowledgeable source.
Greetings: The worker has indicated to the Social Security Administration that their work activity may be performed with employer-provided accommodations or under special conditions which may indicate that the work is subsidized. They have given the Social Security Administration permission to reach out to you to help the Social Security Administration determine whether their work activity is subsidized as defined by Social Security. The information you provide will not be shared with other agencies and is in no way a negative reflection on the employee or the employer. Please assist the Social Security Administration by completing the enclosed questionnaire, even if the worker is no longer employed.
A filled-in Form SSA-3033 example: a supervisor answers Section 1
How to fill out Form SSA-3033, box by box
Employee's Name and Business/Employer Name
Fill in Employee's Name, Employee's SSN, Business/Employer Name, Employee's Job Title, Date Work Started, Date Work Ended (if applicable), Hourly Wage/Salary and Hours per Week.
Section 1
The following questions will help the Social Security Administration to determine if the employer provides accommodations that support the employee's work effort. Please answer the questions based on your direct knowledge of the employee's work activities.
1. Does the employee require additional assistance or employer accommodation to complete job duties? (i.e., job coach, extra help, or supervision, etc.) If yes, please describe in Section 2, Remarks. Yes No
2. Is the employee assigned fewer or easier duties than typically required by the job description? Yes No
3. Does the employee have a special relationship to the employer? (i.e., friend, relative, long-term employee, etc.) If yes, please describe in Section 2, Remarks. Yes No
4. Does the employer accommodate the employee by allowing them to take additional or longer breaks, work fewer hours, extra time to complete work tasks, or have frequent absences? Yes No
5. Does the employer provide any accommodations not covered? If yes, please describe in Section 2, Remarks. Yes No
If any answer is “Yes,” please proceed to Question 6. If all answers are “No,” please proceed to Section 3.
6. Reasonable value of the work or services performed
6. What is the reasonable value of the work or services performed? Approximately what percentage of this employee's pay exceeds the reasonable value of the work or services they perform? Please provide any justification in Section 2, Remarks. 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Other %
Section 2
Section 2 Use the space below to let the Social Security Administration know anything related to this employee's job, work activity or accommodations that was not covered in the questions above and to provide additional information about answers to those questions. Remarks:
Section 3 Contact Information
Section 3 Contact Information Printed Name: Title: Your Organization/Employer Name: Date: (Telephone Number):
More rules for Form SSA-3033
When an employee's work is subsidized, the Social Security Administration does not consider any pay that exceeds the reasonable value of the work or services performed. A subsidy may exist when the employee works under any of the following conditions: receives extra assistance; work activity is limited in nature; has fewer or easier duties than usual for the position; takes additional breaks or time off as an accommodation; or has other special conditions or employer accommodations.
You do not need to answer these questions unless the Social Security Administration displays a valid Office of Management and Budget (OMB) control number.
The Social Security Administration estimates that it will take about 15 minutes to read the instructions, gather the facts, and answer the questions.
Before you go
The Social Security Administration would appreciate it if you would complete and return the questionnaire within 15 days.
The information you provide will help the Social Security Administration determine the true value of the services performed.
Furnishing the Social Security Administration this information is voluntary. However, failing to provide all or part of the information may prevent an accurate and timely decision on any claim filed.
Common questions about Form SSA-3033
Is there a deadline?
The Social Security Administration would appreciate it if you would complete and return the questionnaire within 15 days.
Sources
[1] Form SSA-3033 (01-2026), Work Activity Questionnaire, Social Security Administration (the Official source link on this page).