Information Collection

Request for Withdrawal of Application

IC 43688 under ICR 201201-0960-010 · OMB 0960-0015.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0015 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-521 Request for Withdrawal of Application	Form
SSA-521 Request for Withdrawal of Application Proposed SSA 521.pdf	Form
SSA-521 - Current Version.pdf Current SSA-521	IC Document

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:

table that charts list of 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	Proposed SSA 521.pdf		No		Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 39,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	39,000	-61,000	100,000
Annual IC Time Burden (Hours)	3,250	-5,083	8,333
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Current SSA-521	SSA-521 - Current Version.pdf	03/30/2012

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.