Form SSA-820-BK at a glance
What it is: Form SSA-820-BK is the Social Security Administration's Work Activity Report - Self-Employment.
Where and when to file: Complete and return this form within 15 days. A pre-addressed envelope is enclosed.
The form applies if there is information that you have been self-employed since your disability began, since your date of entitlement to benefits, or since your last work review.
What to bring and attach to Form SSA-820-BK
SSA may ask for proof of any of the information you provide.
A filled-in Form SSA-820-BK example: a gardener reports self-employment
How to fill out Form SSA-820-BK, box by box
IDENTIFICATION
Under IDENTIFICATION, enter the Name of Claimant or Beneficiary and the BNC# or SSN, and mark Blind or Not Blind.
Provide information since the date shown, which SSA completes. If a date is not shown, provide information for the last two years.
Self-employment activity
Check one box for any self-employment activity or self-employment income since the date shown in the IDENTIFICATION section, or within the last two years. NO: if you were not self-employed, go to question 2. YES: if you have been self-employed, go to the SELF-EMPLOYMENT INFORMATION section, question 3.
Other types of income
The information SSA has may include reports of other types of income for you even if you are not self-employed. Other types of income include income after your business closed, income from sale of the business, and disability pay/ insurance.
Did you receive other types of income since the date shown or within the last two years? NO: if you did not receive any other type of income and have not worked, please specify any possible source of reported income, then go to the SIGNATURE section, complete, sign and return the form.
YES: tell SSA about that income, then go to the SIGNATURE section, complete, sign and return the form. Enter the type of income, source of income, amount, date(s) paid, etc.
Name of Business (if applicable)
Tell SSA about your self-employment since the date shown in the IDENTIFICATION section, or within the last two years.
Enter the Name of Business (if applicable), Telephone # (include area code), Mailing address, City, State, ZIP Code, Fax # (include area code) and Primary Product or Service.
Average Hours (hrs) Worked Per Month
Under Average Hours (hrs) Worked Per Month, mark 80 hrs or more per month, At least 45 but less than 80 hrs per month, or Less than 45 hrs per month.
Date Work Started (MM/DD/YYYY)
Enter the Date Work Started and the Date Work Ended as MM/DD/YYYY, or mark Still Working.
Reason Work Ended (if applicable)
Under Reason Work Ended (if applicable), mark Because of my disability or other reason(s).
What best describes your type of self-employment/business arrangement? (Check One)
Check one: Sole Owner, Partnership, Limited Liability Company (LLC), Corporation, Independent Contractor, Gig Work*, Farm Landlord, Farm Tenant or Other (Please explain).
Use the space to tell SSA more about the business arrangement(s) you checked, and if other, the type of business arrangement.
Tax Returns
4A. Attach all your self-employment tax returns (including Schedule C & SE, 1099s, etc.) since the date shown in the IDENTIFICATION section, or for the last two years.
Mark I have ENCLOSED my Tax Returns or I DO NOT have Tax Returns.
For any years that you DO NOT have tax returns, use the chart to tell SSA about your total annual gross and net self-employment income by Year (YYYY), Gross and Net.
estimate of your expected income
4B. If you are currently self-employed, provide an estimate of your expected income by Year (YYYY), Gross and Net.
management responsibilities
5A. Did anyone other than you have management responsibilities for any business shown in question 3 (i.e., a partner, employee, relative, or helper) since the DATE shown in the IDENTIFICATION section, or within the last two years? NO: go to Question 6A. YES: go to question 5B.
WORK INCENTIVES
WORK INCENTIVES 6A. SSA may not count short periods of work (6 months or less) when SSA decides if you are eligible for benefits. For any work that you told SSA about in the SELF-EMPLOYMENT INFORMATION section, did you make any changes to your work due to your disability, or due to the removal of special conditions that allowed you to work? NO: go to Question 7A. YES: go to Question 6B.
6B. Mark any that apply, provide requested information, then go to question 7A. Mark I stopped working within 6 months or less. Mark I changed to fewer hours of work or less earnings within 6 months or less. Mark I changed to a lighter or easier type of work. Each is due to my disability or due to the removal of special conditions that allowed me to work.
expenses
7A. SSA may be able to deduct certain expenses from your net earnings from self-employment before SSA decides if you are eligible to receive or continue to receive benefits.
The expenses must be for items or services that you pay for, that are needed because of your disability, and that are needed for you to work. The expenses must be paid for out of pocket. SSA cannot count expenses that Medicare, Medicaid, an insurance company, or another person paid or will pay back to you. Do not include any expenses, including business expenses, that you will claim as an expense on your tax return filed with the Internal Revenue Service (IRS).
Did you spend any of your own money for items or services related to your disability that you needed for you to work? NO: go to SIGNATURE section, complete, sign and return the form. YES: go to question 7B.
business expenses paid by another person or agency
8. When SSA determines your countable income, it may be able to deduct from your net income any business expenses which were incurred and paid by another person or agency. Has any person or organization (i.e., Vocational Rehabilitation or other State or local agency) contributed to or paid for business expenses or provided any free help, items or services related to your business since the date shown in the IDENTIFICATION section? NO: go to SIGNATURE section. YES: explain.
Signature of Claimant, Beneficiary or Representative Payee
Sign as the Claimant, Beneficiary or Representative Payee and enter the Date, Area Code and Telephone Number, Mailing Address (Number and Street, Apt. No., P.O. Box, or Rural Route), City, State and ZIP Code.
I authorize any employer, agency, or other organization to disclose to the Social Security Administration or the State agency that may determine or review my entitlement to disability benefits, any information about my physical and/or mental condition or my work.
I declare under penalty of perjury that I have examined all the information on this form, and on any accompanying statements or forms, and it is true and correct to the best of my knowledge.
I understand that anyone who knowingly gives a false or misleading statement about a material fact in this information, or causes someone else to do so, commits a crime and may be sent to prison, or may face other penalties, or both.
Signature of Witness
If this statement is signed with a mark (e.g., X), two individuals who know the person making the statement must witness the signature and sign, giving their full addresses and telephone numbers: Signature of Witness, Date, Area Code and Telephone Number, Mailing Address, City, State and ZIP Code.
More rules for Form SSA-820-BK
If you do not return this form, SSA may make its decision based on the information it has in its records.
Common questions about Form SSA-820-BK
What is the SSA 820 form?
The Social Security Administration writes to you because it believes you may have recent self-employment work activity and needs to know more about this work activity.
Is there a deadline?
Complete and return this form within 15 days.
Sources
[1] Form SSA-820-BK (03-2026), Work Activity Report - Self-Employment, Social Security Administration (the Official source link on this page).