OMB control number

Request for Withdrawal of Application

OMB 0960-0015 · SSA.

OMB 0960-0015

SSA employees collect Form SSA-521, which documents the information SSA needs to process the withdrawal of an application for benefits. 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. Each time an individual wishes to withdraw an application for benefits, he or she completes and signs Form SSA-521. Typically, respondents complete the form themselves and will not need information from someone else to complete the form. SSA uses the information from the SSA-521 to process the request for withdrawal. The respondents are beneficiaries or applicants for Retirement, Survivors, Disability, and Health Insurance benefits.

The latest form for Request for Withdrawal of Application expires 2026-06-30 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form SSA-521 Request for Withdrawal of Application Form
Addendum - 0015 (Final).docx Supplementary Document
Supporting Statement - 0015 (Final).docx Supporting Statement A
Request for Withdrawal of Application Form

All Historical Document Collections

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