OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Request for Withdrawal of Application

IC 43688 under ICR 202105-0960-006 · OMB 0960-0015.

Documents and Forms
Document Name
Document Type
Form
Form
Other-Revised PA and PRA Statements
Other-Revised PA and PRA Statements
Form
Form
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Request for Withdrawal of Application
 
No Modified
 
Required to Obtain or Retain Benefits
 
20 CFR 404.640

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
Other-Revised PA and PRA Statements Revised PA & PRA Statements.pdf Yes No Fillable Printable

Income Security General Retirement and Disability

 

75,127 0
   
Individuals or Households
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 75,127 0 0 43,300 0 31,827
Annual IC Time Burden (Hours) 6,261 0 0 3,609 0 2,652
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
SSA-521 - Current SSA-521 - Current.pdf 09/07/2021
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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