REQUEST FOR WITHDRAWAL OF APPLICATION

ICR 197908-0960-004

OMB: 0960-0015

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC ID
Document
Title
Status
114253 Migrated
ICR Details
0960-0015 197908-0960-004
Historical Active 197406-0960-001
SSA
REQUEST FOR WITHDRAWAL OF APPLICATION
Extension without change of a currently approved collection   No
Regular
Approved without change 08/22/1979
Retrieve Notice of Action (NOA) 08/03/1979
  Inventory as of this Action Requested Previously Approved
08/31/1984 08/31/1984 08/31/1979
100,000 0 100,000
8,333 0 8,333
0 0 0

REGULATORY AUTHORITY 20 CFR 404.615 PROVIDES THAT A CLAIMANT MAY WITHDRAW HIS APPLICATION FOR SOCIAL SECURITY BENEFITS. IN ORDER FOR A CLAIM TO BE WITHDRAWN SSA NEEDS THE INFORMATION ELICITED ON THIS FORM. THE DATA OBTAINED IS USED TO PROCESS THE REQUEST FOR WITHDRAWAL.

None
None


No

1
IC Title Form No. Form Name
REQUEST FOR WITHDRAWAL OF APPLICATION SSA-521

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 100,000 100,000 0 0 0 0
Annual Time Burden (Hours) 8,333 8,333 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
08/03/1979


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