Supporting Statement for Form SSA-521
Request for Withdrawal of Application
20 CFR 404.640
OMB NO. 0960-0015

A. 	Justification

1.		Section 205(a) of the Social Security Act authorizes the Commissioner of Social Security to "make rules and regulations and to establish procedures, not inconsistent with the provisions of this title, which are...appropriate to carry out such provisions..."  20 CFR 404.640 of the Code of Federal Regulations provides that an individual may withdraw an application for benefits before or after the Social Security Administration (SSA) makes a determination of eligibility.  In some cases, the filing of an application for benefits may be to the claimants' disadvantage. The withdrawal procedure provides a method for overcoming and nullifying this disadvantage.
2.		Form SSA-521 collects the required information to make withdrawal of an application for benefits.  Individuals who wish to withdraw their applications for benefits complete form SSA-521. SSA uses the information from Form SSA-521 to process the request for withdrawal.  The respondents are applicants for Retirement, Survivors, Disability and Health Insurance (RSDHI) benefits.
3.		Form SSA-521 is available on SSA's website for individuals to print, complete, and mail to SSA for processing.  An electronic version is not available, due to higher volume forms taking precedence. 
4.	The nature of the information we are collecting and the manner in which we are collecting it preclude duplication.  SSA does not use another collection instrument to collect similar data.  
5.	This collection does not affect small businesses or other small entities.
6.	If SSA did not collect the information, we would not be able to determine if the withdrawal of the application is in the claimant's best interest.  In addition, since SSA collects this information on an as needed basis, we cannot collect it less frequently. There are no technical or legal obstacles to burden reduction.
7.	There are no special circumstances that would cause SSA to conduct this information collection in a manner that is not consistent with 5 CFR 1320.5.
8.	The 60-day advance Federal Register Notice published on February 17, 2009, at 74 FR 7509, and SSA received no public comments.  The second Notice published on      April 24, 2009, at 74 FR 18782.  SSA did not consult members of the public in the development of this form.
9.	SSA provides no payment or gifts to the respondents. 
10.	SSA protects and holds confidential the information it is requesting in accordance with 42 U.S.C. 1306, 20 CFR 401 and 402, 5 U.S.C. 552 (Freedom of Information Act), 5 U.S.C. 552a (Privacy Act of 1974), and OMB Circular No. A-130.
11.	The information collection does not contain any questions of a sensitive nature.
12.	Approximately 100,000 respondents use the SSA-521 annually.  The estimated response time for completion of the form is 5 minutes for a total of 8,333 burden hours.  The total burden represents burden hours, and SSA did not calculate a separate cost burden.
13.	There is no known cost burden to the respondents. 
14.	The annual cost to the Federal government is approximately $160,000.  This estimate is a projection of the costs for printing, distributing the collection instrument, and for the collection of information. 
15.	There are no changes in the public reporting burden. 
16.	SSA will not publish the results of the information collection. 
17.	OMB exempted SSA from the requirement to print the OMB approval expiration date on its program forms. SSA produces millions of public-use forms, many of which have a life cycle longer than that of an OMB approval.  SSA does not periodically revise and reprint its public-use forms (e.g., on an annual basis).  OMB granted this exemption so the agency would not have to discontinue using otherwise useable editions of forms with outdated expiration dates.  In addition, SSA avoids Government waste, because we will not have to destroy and reprint stocks of forms.   
18.	SSA is not requesting an exception to the certification requirements at 5 CFR 1320.9 and related provisions at 5 CFR 1320.8(b)(3).
B.        Collection of Information Employing Statistical Methods 
           SSA is not using statistical methods for this collection.