Request for Withdrawal of Application

Documents and Forms

Document Name Document Type
Form SSA-521 Request for Withdrawal of Application Form
Revised PA & PRA Statements.pdf Other-Revised PA and PRA Statements
SSA-521 Request for Withdrawal of Application SSA-521 - Revised.pdf Form
SSA-521 - Current.pdf SSA-521 - Current 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
Other-Revised PA and PRA Statements			Revised PA & PRA Statements.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: 75,127	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

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

Documents for IC

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.