Report work and wages online form

This online service allows you to electronically complete, sign, and submit the Work Activity Report – Employee (Form SSA-821). You may use this online service as an alternative to completing a paper version of this form. To complete the form online, you will need a valid email address.

PRIOR TO USING THIS OPTION, YOU MAY HAVE RECEIVED A REQUEST TO COMPLETE A WORK ACTIVITY REPORT – EMPLOYEE (FORM SSA-821) FROM SOCIAL SECURITY.

Before beginning the form, you will enter and confirm your email address in the online application.

You will receive an email from adobesign@adobesign.com containing a link and instructions on how to access the form. The link will expire after fifteen (15) calendar days. If the link expires, you will need to return to this page to request a new link.

IMPORTANT: We will not process the form until you complete the form, sign the form electronically, and select “Click to Sign” to submit the form. Upon submission, you will be able to download a copy of the signed form within the application. We recommend that you save a copy for your records. You will receive an email confirming your submission.

PLEASE NOTE:

• This website is most compatible with Microsoft Edge and Google Chrome.
• The form must be electronically completed, signed, and submitted in a single session.
• The system will end your session after 60 minutes of inactivity and no information will be saved.
• An email reminder will be sent every three (3) days for fifteen (15) days or until the form has been submitted.
• If you do not receive an email notification within a few minutes of your online submission, be sure to check your email’s junk folder.

Sections 223(d) and 1633 of the Social Security Act, as amended, allow us to collect this information. Furnishing us 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 or could result in an overpayment of benefits.

We will use the information to make a determination of eligibility for benefits. We may also share your information for the following purposes, called routine uses:

• To employers, current or former, for correcting or reconstructing earnings records and for Social Security tax purposes; and
• To contractors and other Federal agencies, as necessary, for the purpose of assisting Social Security Administration in the efficient administration of its programs.

In addition, we may share this information in accordance with the Privacy Act and other Federal laws. For example, where authorized, we may use and disclose this information in computer matching programs, in which our records are compared with other records to establish or verify a person's eligibility for Federal benefit programs and for repayment of incorrect or delinquent debts under these programs.