OMB.report

Federal forms, ICRs, and supporting documents

OMB control number

Request for Withdrawal of Application

OMB 0960-0015 · SSA.

OMB 0960-0015

Form SSA 521, Request for Withdrawal of Application, allows claimants to specify which application they want to withdraw and the reason for the withdrawal. Form SSA-521 is our preferred instrument for a withdrawal request; however, any written request for withdrawal signed by the claimant or a proper applicant 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 Form SSA 521 to process the request for withdrawal. The respondents are applicants for Retirement, Survivors, Disability, and Health Insurance benefits.

The latest form for Request for Withdrawal of Application expires 2029-10-31 and is listed under ICR 202603-0960-017.

View the official OMB control history on Reginfo.gov.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
DocumentType
Form SSA-521 Request for Withdrawal of ApplicationForm
Form SSA-521 Request for Withdrawal of ApplicationForm
Addendum - 0015 (Final).docxSupplementary Document
Supporting Statement-0015 (Final).docxSupporting Statement A
Request for Withdrawal of Application - SSA-521 submitted before approving benefit application (pre-adjudication). Form
Request for Withdrawal of Application - SSA-521 submitted before approving benefit application (pre-adjudication). Form
Request for Withdrawal of Application - SSA-521 submitted before approving benefit application (pre-adjudication). Other-Revised PA Statement
Request for Withdrawal of Application - SSA-521 submitted after receiving benefits. (post-adjudication) Form
Request for Withdrawal of Application - SSA-521 submitted after receiving benefits. (post-adjudication) Form
Request for Withdrawal of Application - SSA-521 submitted after receiving benefits. (post-adjudication) Other-Revised Privacy Act Statement

All Historical Document Collections

Historical document collections
ReferenceFilingReceivedConcludedAction
202603-0960-017 Revision of a currently approved collection 2026-06-26
202105-0960-006 Revision of a currently approved collection 2021-09-09 Approved with change
201802-0960-001 Revision of a currently approved collection 2018-06-25 Approved with change
201708-0960-004 No material or nonsubstantive change to a currently approved collection 2017-08-04 Approved without change
201605-0960-004 No material or nonsubstantive change to a currently approved collection 2016-08-12 Approved without change
201502-0960-009 Revision of a currently approved collection 2015-06-02 Approved without change
201201-0960-010 Revision of a currently approved collection 2012-05-18 Approved without change
200901-0960-001 Revision of a currently approved collection 2009-04-28 Approved without change
200606-0960-011 Extension without change of a currently approved collection 2006-06-14 Approved without change
200308-0960-002 Revision of a currently approved collection 2003-08-22 Approved without change
200009-0960-016 No material or nonsubstantive change to a currently approved collection 2000-09-18 Approved without change
200007-0960-008 Extension without change of a currently approved collection 2000-07-31 Approved without change
199707-0960-004 Extension without change of a currently approved collection 1997-07-17 Approved without change
199403-0960-005 Revision of a currently approved collection 1994-03-31 Approved without change
199102-0960-007 Extension without change of a currently approved collection 1991-02-06 Approved without change
198912-0960-005 Extension without change of a currently approved collection 1989-12-22 Approved without change
198703-0960-001 Revision of a currently approved collection 1987-03-11 Approved without change
198508-0960-012 No material or nonsubstantive change to a currently approved collection 1985-08-29 Approved with change
198405-0960-010 Extension without change of a currently approved collection 1984-05-22 Approved without change
198107-0960-008 No material or nonsubstantive change to a currently approved collection 1981-07-17 Approved with change
197908-0960-004 Extension without change of a currently approved collection 1979-08-03 Approved without change
197406-0960-001 New collection (Request for a new OMB Control Number) 1974-06-18 Approved without change

OMB Details

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

Federal Enterprise Architecture: Income Security - General Retirement and Disability

Information collection instruments
FormNameElectronic accessType
Form SSA-521Request for Withdrawal of ApplicationFillable PrintableForm

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.