REQUEST FOR WITHDRAWAL OF APPLICATION

ICR 198912-0960-005

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
114256 Migrated
ICR Details
0960-0015 198912-0960-005
Historical Active 198703-0960-001
SSA
REQUEST FOR WITHDRAWAL OF APPLICATION
Extension without change of a currently approved collection   No
Regular
Approved without change 02/23/1990
Retrieve Notice of Action (NOA) 12/22/1989
This information collection request is approved through February, 1991 As a condition of approval, SSA must justify the practical utility of of requiring respondents to state the reasons for their withdrawl of the application.
  Inventory as of this Action Requested Previously Approved
02/28/1991 02/28/1991 04/30/1990
50,000 0 50,000
4,166 0 4,166
0 0 0

THE INFORMATION COLLECTED VIA THE SSA-521 IS NEEDED TO EFFECTUATE AN INDIVIDUAL'S WITHDRAWAL OF A CLAIM FOR SOCIAL SECURITY BENEFITS. THE AFFECTED PUBLIC IS COMPRISED OF INDIVIDUALS WHO DESIRE TO WITHDRAW APPLICATIONS FOR SOCIAL SECURITY BENEFITS.

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 50,000 50,000 0 0 0 0
Annual Time Burden (Hours) 4,166 4,166 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.
12/22/1989


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