Information Collection

Request for Withdrawal of Application - SSA-521 submitted after receiving benefits. (post-adjudication)

IC 280824 under ICR 202603-0960-017 · OMB 0960-0015.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-521 Request for Withdrawal of Application Request for Withdrawal of Application - SSA-521 submitted after receiving benefits. (post-adjudication)	Form
Privacy Act Statement -Revised.docx	Other-Revised Privacy Act Statement
SSA-521 Request for Withdrawal of Application ssa-521 -Revised.pdf	Form
ssa-521 - current.pdf SSA-521-Current	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

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				Yes	Yes	Fillable Printable
Other-Revised Privacy Act Statement					Yes	No	Printable Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 61,896

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 27 %

table that charts list of burden
	Requested	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	61,896	61,896
Annual IC Time Burden (Hours)	61,896	61,896
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
SSA-521-Current		06/08/2026

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

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