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Federal forms, ICRs, and supporting documents

Information Collection

Request for Withdrawal of Application - SSA-521 submitted before approving benefit application (pre-adjudication).

IC 43688 under ICR 202603-0960-017 · OMB 0960-0015.

Documents and Forms
Document Name
Document Type
Form
Other-Revised PA Statement
Form
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Request for Withdrawal of Application - SSA-521 submitted before approving benefit application (pre-adjudication).
 
No Modified
 
Required to Obtain or Retain Benefits
 
20 CFR 404.640

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 ssa-521 -Revised.pdf Yes Yes Fillable Printable
Other-Revised PA Statement Revised Privacy Act Statement-SSA-521.docx No   Paper Only

Income Security General Retirement and Disability

 

19,995 0
   
Individuals or Households
 
   27 %

  Requested Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 19,995 0 0 -55,132 0 75,127
Annual IC Time Burden (Hours) 19,995 0 0 13,734 0 6,261
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
SSA-521 - Current ssa-521 - current.pdf 04/16/2026
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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