Information Collection

Request for Withdrawal of Application

IC 43688 under ICR 201802-0960-001 · OMB 0960-0015.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0015 can be found here:

Documents and Forms

Document Name Document Type
Form SSA-521 Request for Withdrawal of Application Form
SSA-521 Request for Withdrawal of Application SSA-521 (revised).pdf Form
SSA-521 (current).pdf Current SSA-521 IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Request for Withdrawal of Application	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 404.640

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SSA-521	Request for Withdrawal of Application	SSA-521 (revised).pdf		Yes	No	Fillable Printable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 31,827	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	31,827	-7,173	39,000
Annual IC Time Burden (Hours)	2,652	-598	3,250
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Current SSA-521	SSA-521 (current).pdf	06/25/2018

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.