Request for Withdrawal of Application
20 CFR 404.640
A. Justification
Introduction/Authoring Laws and Regulations
20 CFR 404.640 of the Code of Federal Regulations provides an individual with the option to withdraw their application for benefits before or after the Social Security Administration (SSA) makes a determination of eligibility.
Form SSA-521, Request for Withdrawal of Application, allows claimants to specify which application they want to withdraw and the reason for the withdrawal.
Description of Collection
Form SSA-521 documents the information SSA needs to process the withdrawal of an application for benefits. A paper Form SSA-521 is our preferred instrument for executing a withdrawal request; however, any written request for withdrawal the claimant signs, or proper applicant signs on the claimant’s behalf, will suffice. Individuals who wish to withdraw their applications for benefits complete Form SSA-521 or sign the completed form for each request to withdraw. SSA uses the information from the SSA-521 to process the request for withdrawal. The respondents are applicants or claimants for Retirement, Survivors, Disability, and Health Insurance benefits.
Use of Information Technology to Collect the Information
Form SSA-521 is available on SSA's website as a fillable, portable document format (PDF) for individuals to complete, print, and mail to SSA for processing. SSA did not create an electronic version of Form SSA-521 under the agency’s Government Paperwork Elimination Act (GPEA) plan because only 31,827 respondents complete the form. This is less than the GPEA
cut-off of 50,000.
Why We Cannot Use Duplicate Information
The nature of the information we collect and the manner in which we collect it preclude duplication. SSA does not use another collection instrument to collect similar data.
Minimizing Burden on Small Respondents
This collection does not affect small businesses or other small entities.
Consequence of Not Collecting Information or collecting it Less Frequently If we did not use Form SSA-521, claimants would not be able to withdraw their application for benefits. Because we only collect the information on an as needed basis, we cannot collect it less frequently. There are no technical or legal obstacles to burden reduction.
Special Circumstances
There are no special circumstances that would cause SSA to conduct this information collection in a manner not consistent with 5 CFR 1320.5.
Solicitation of Public Comment and Other Consultations with the Public
The 60-day advance Federal Register Notice published on March 21, 2018, at
83 FR 12455, and we received no public comments. The 30-day FRN published on June 8, 2018 at 83 FR 26736. If we receive any comments in response to this Notice, we will forward them to OMB. We did not consult with the public in the revision of this form
Payment or Gifts to Respondents
SSA does not provide payments or gifts to the respondents.
Assurances of Confidentiality
SSA protects and holds confidential the information it collects 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.
Justification for Sensitive Questions
The information collection does not contain any questions of a sensitive nature.
Estimates of Public Reporting Burden
Approximately 31,827 respondents take 5 minutes each to complete Form
SSA-521 each year. Accordingly, the burden is 2,652 hours:
Modality of Completion |
Number of Respondents |
Frequency of Response |
Average Burden Per Response (minutes) |
Estimated Total Annual Burden (hours) |
SSA-521 |
31,827 |
1 |
5 |
2,652 |
We based these figures on current management information data. This figure represents burden hours, and we did not calculate a separate cost burden.
13. Annual Cost to the Respondents (Other)
This collection does not impose a known cost burden on the respondents.
Annual Cost To Federal Government
The annual cost to the Federal Governments is approximately $274,934. This estimate accounts for costs from the following areas: (1) designing, printing, and distributing the form; and (2) SSA employee (e.g., field office, 800 number, DDS staff) information collection and processing time.
15. Program Changes or Adjustments to the Information Collection Request
When we last cleared this IC in 2015, the burden was 3,250 hours. However, we are currently reporting a burden of 2,652 hours. This change stems from a change in the regulations at 20 CFR 404.640, which now limit individuals to one
withdrawal approval per lifetime, and they submit the request for withdrawal within 12 months of their current date of entitlement. There is no change to the burden time per response. Although the number of responses changed, SSA did not take any actions to cause this change.
16. Plans for Publication Information Collection Results
SSA will not publish the results of the information collection.
17. Displaying the OMB Approval Expiration Date
OMB granted SSA an exemption from the requirement to print the OMB expiration date on its program forms. SSA produces millions of public-use forms with life cycles exceeding those of an OMB approval. Since SSA does not periodically revise and reprint its public-use forms (e.g., on an annual basis), OMB granted this exemption so SSA would not have to destroy stocks of otherwise useable forms with expired OMB approval dates, avoiding Government waste.
Exceptions to Certification Statement
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. Collections of Information Employing Statistical Methods
SSA does not use statistical methods for this information collection.
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| File Title | Title of Information Collection and Form Number(s) |
| Author | Naomi |
| File Modified | 0000-00-00 |
| File Created | 2021-01-21 |