Addendum to Supporting Statement 0015

Addendum to the Supporting Statement for Form SSA-521

Request for Withdrawal of Application

20 CFR 404.640

OMB No. 0960-0015

Revision to the Collection Instrument

• Change #1: We are revising the language in the “IMPORTANT NOTICE” section at the top of the form:

  • Old Language: “This is a request to cancel your application.”

  • New Language: “This is a request to withdraw your application.”

Justification #1: We revised the wording to remain consistent with the terminology.

• Change #2: We are revising the Privacy Act Statement on this form.

Justification #2: SSA’s Office of the General Counsel is conducting a systematic review of SSA’s Privacy Act Statements on agency forms. As a result, SSA is updating the Privacy Act Statement on the form.