Addendum to the Supporting Statement for 0960-0015

Addendum to the Supporting Statement for Form SSA-521

Request for Withdrawal of Application

OMB No. 0960-0015

Revisions to the Collection Instrument

We are making the following changes to the SSA-521:

• Change 1:

  • “Important Notice” section—we changed the language in this section

From:

“This is a request to cancel your application.  If it is approved, the decision we made on your application will have no legal effect, all rights attached to an application, including the rights of reconsideration, hearing, and appeal will be forfeited, and any payments we made to you or anyone else on the basis of that application will have to be returned.  You must then reapply if you want a determination of your Social Security rights at any time in the future but any subsequent application may not involve the same retroactive period.  This procedure is intended to be used only when your decision to file has resulted, or will result, in a disadvantage to you.  Your local Social Security office will be glad to explain whether, and how, this procedure will help you.”

To:

“This is a request to cancel your application. If we approve it, the decision we made on your application will have no legal effect. You will forfeit all rights attached to an application, including the rights of appeal. You will have to return any payment we made to you or anyone else on the basis of that application. You must then reapply if you want a determination of your Social Security rights at any time in the future. Any subsequent application may not involve the same retroactive period. We intend for you to use this procedure only when your decision to file has resulted, or will result, in a disadvantage to you. Your local Social Security office will be glad to explain whether, and how, this procedure will help you.” 

• Justification 1:  We revised this language to change passive language to active and to remove ambiguous words.

• Change 2:

  • “Name Section” – we added a line to put the name of the person requesting the withdrawal, if different from the wage earner.

• Justification 2:  On some occasions, the person making the withdrawal request is different from the wage earner.  This new line will allow the requestor to give his or her own name.  This new information will help the SSA technician identify which person on the account system’s inputs will apply.

• Change 3:

  • “Name Section” – we added a line to put the Social Security number of the person requesting the withdrawal, if different from the wage earner.

• Justification 3:  On some occasions, the person making the withdrawal request is different from the wage earner.  This new line will allow the requestor to give his or her own Social Security number.  This new information will help the SSA technician identify which person on the account system’s inputs will apply.

• Change 4:

  • “Type of Application” question—we removed this question.

• Justification 4:  Often the claimant completes this form without assistance from an SSA employee.  We removed this question because we feel it does not have any relevance to the claimant.

• Change 5:

  • “Type of Benefit” question – we reworded this question

    • From: “Type of Benefit”

    • To: “Type of benefit you want to withdraw”

• Justification 5:  We reworded this question to assist claimants when completing this form with no assistance from an SSA employee.  We feel this revision will make it easier for the claimant to identify which benefit he or she is withdrawing.

• Change 6:

  • We added the following yes-or-no question: “If applicable, do you want to keep Medicare benefits?”

• Justification 6:  When the Program Service Center (PSC) receives the completed form, the technician often has to make a second contact with the claimant to determine if he or she would like to continue to receive Medicare benefits.  This question eliminates the need for the recontact, thus cutting down on processing time.

• In addition:

  • We updated the Paperwork Reduction Act Statement, as the current form shows an outdated version of the statement.

SSA would like to start using the new version of the form immediately upon OMB approval. We will destroy all stocks of the old version.