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Making the decision to withdraw a Social Security application is significant and involves careful consideration. The Form SSA-521, also known as the "Request for Withdrawal of Application," serves as a formal request to the Social Security Administration (SSA) to cancel a previously filed application for benefits. This can encompass retirement, disability, or Medicare benefits, among others. Crucially, approval of this request means that any decision made on the initial application will be nullified, effectively erasing the legal effect of that decision. The implications of such a withdrawal are far-reaching: individuals must return any benefits received, forfeit rights attached to the withdrawn application—including appeal rights—and understand that reapplication might not cover the same retroactive period. Furthermore, the SSA underscores the importance of this form by stipulating that it should only be used when the initial filing disadvantages the applicant. The process requires detailed information about the applicant, the type of benefit being withdrawn, an explicit acknowledgment of understanding the consequences of withdrawal, and, notably, repayment of any benefits previously disbursed. This form embodies a crucial administrative remedy for those facing unexpected disadvantages from their initial application choice, offering a potential pathway to rectify those unintended consequences.

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Form SSA-521 (07-2023) UF

 

 

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Social Security Administration

TOE 420

OMB No. 0960-0015

REQUEST FOR WITHDRAWAL OF APPLICATION

Do not write in this space

IMPORTANT NOTICE - This is a request to withdraw your application. If we approve it, the decision we made on your application will have no legal effect. You will forfeit all rights attached to an application, including the rights of appeal. You will have to return any payment we made to you or anyone else on the basis of that application. You must then reapply if you want a determination of your Social Security rights at any time in the future. Any subsequent application may not involve the same retroactive period. We intend for you to use this procedure only when your decision to file has resulted, or will result, in a disadvantage to you. Your local Social Security office will be glad to explain whether, and how, this procedure will help you.

 

NAME OF WAGE EARNER, SELF-EMPLOYED INDIVIDUAL, OR ELIGIBLE INDIVIDUAL

 

 

SOCIAL SECURITY NUMBER

 

 

 

 

 

 

IF DIFFERENT, PRINT YOUR NAME (First name, middle initial, last name)

YOUR SOCIAL SECURITY NUMBER

 

 

 

 

TYPE OF BENEFIT YOU WANT TO WITHDRAW

DATE OF APPLICATION IF

APPLICABLE, DO YOU WANT TO KEEP

 

 

MEDICARE BENEFITS? Yes

No

I hereby request the withdrawal of my application, dated as above, for the reasons stated below. I understand that (1) this request may not be canceled after 60 days from the mailing of notice of approval; and (2) if a determination of my entitlement has been made, there must be repayment of all benefits paid on the application I want withdrawn, and all other persons whose benefits would be affected must consent to this withdrawal. I further understand that the application withdrawn and all related material will remain a part of the records of the Social Security Administration and that this withdrawal will not affect the proper crediting of wages or self-employment income to my Social Security earnings record.

Give reason for withdrawal. (If you need more space, see additional remarks)

1.I intend to continue working. (I have been advised of the alternatives to withdrawal for applicants under full retirement age and still wish to withdraw my application.)

2.

Other (Please explain fully):

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

See additional remarks

I declare under penalty of perjury that I have examined all the information on this form, and on any accompanying statements or forms, and it is true and correct to the best of my knowledge. I understand that anyone who knowingly gives a false statement about a material fact in this information, or causes someone else to do so, commits a crime and may be subject to a fine or imprisonment.

 

 

 

 

 

 

 

 

 

SIGNATURE OF PERSON MAKING REQUEST

Signature (First name, middle initial, last name) (Write in ink)

 

Date (Month, day, year)

 

SIGN

 

 

 

 

 

 

 

 

Telephone Number (include area code)

 

HERE

 

 

 

 

 

 

 

 

 

 

 

 

Mailing Address (Number and Street, Apt. No., P.O. Box, or Rural Route)

 

 

 

 

 

 

 

 

 

 

City and State

 

ZIP Code

Enter Name of County (if any) in which you now live

 

 

 

 

 

 

 

 

Witnesses are required ONLY if this request has been signed by mark (X) above. If signed by mark (X), two witnesses to the signing who know the person making the request must sign below, giving their full addresses.

1. Signature of Witness

2. Signature of Witness

Address (Number and Street, City, State and ZIP Code)

Address (Number and Street, City, State and ZIP Code)

FOR USE OF SOCIAL SECURITY ADMINISTRATION

APPROVED Signature Field

NOT APPROVED BECAUSE

BENEFITS NOT

CONSENT(S) NOT

OTHER

REPAID

OBTAINED

(Attach special determination)

 

TITLE

OTHER (Specify)

 

DATE

 

CLAIMS SPECIALIST

 

 

 

 

 

 

 

Form SSA-521 (07-2023) UF

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Additional Remarks:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Privacy Act Statement

Collection and Use of Personal Information

Sections 202, 205, 223 and 1872 of the Social Security Act, as amended, allow us to collect this information. Furnishing us this information is voluntary. However, failing to provide all or part of the information may prevent withdrawal of the application for benefits.

We will use the information you provide to cancel your application for benefits. We may also share the information for the following purposes, called routine uses:

To contractors and other Federal Agencies, as necessary, for the purpose of assisting us in the efficient administration of our programs. We will disclose information under this routine use only in situations in which we may enter into a contractual or similar agreement to obtain assistance in accomplishing an SSA function relating to this system of records; and,

To student volunteers, individuals working under a personal services contract, and other workers who technically do not have the status of Federal employees, when they are performing work for us, as authorized by law, and they need access to personally identifiable information (PII) in our records in order to perform their assigned agency functions.

In addition, we may share this information in accordance with the Privacy Act and other Federal laws. For example, where authorized, we may use and disclose this information in computer matching programs, in which our records are compared with other records to establish or verify a person's eligibility for Federal benefit programs and for repayment of incorrect or delinquent debts under these programs.

A list of additional routine uses is available in our Privacy Act System of Records Notice (SORN) 60-0089, entitled, Claims Folders System, as published in the Federal Register (FR) on October 31, 2019, at 84 FR 58422. Additional information, and a full listing of all of our SORNs, is available on our website at www.ssa.gov/privacy.

Paperwork Reduction Act Statement - This information collection meets the requirements of 44 U.S.C. § 3507, as amended by section 2 of the Paperwork Reduction Act of 1995. You do not need to answer these questions unless we display a valid Office of Management and Budget control number. We estimate that it will take about 5 minutes to read the instructions, gather the facts, and answer the questions. SEND OR BRING THE COMPLETED FORM TO YOUR LOCAL SOCIAL SECURITY OFFICE. You can find your local Social Security office through SSA's website at www.socialsecurity.gov. Offices are also listed under U. S. Government agencies in your telephone directory or you may call Social Security at 1-800-772-1213 (TTY 1-800-325-0778).

You may send comments regarding this burden estimate or any other aspect of this collection, including suggestions for reducing this burden to: SSA, 6401 Security Blvd, Baltimore, MD 21235-6401. Send only comments relating to our time estimate or other aspects of this collection to this address, not the completed form.

Document Attributes

Fact Name Description
Form Number SSA-521 (07-2023) UF
Purpose Request for Withdrawal of Application
Important Notice Withdrawing an application voids the decision made on that application and forfeits all rights attached, including rights of appeal.
Reapplication Applicants must return any payments received and may reapply for Social Security rights in the future, possibly without the same retroactive period.
Consent Requirement All other persons whose benefits would be affected must consent to the withdrawal of the application.
Record Keeping The withdrawn application and all related material remain part of the records of the Social Security Administration but do not affect the crediting of wages or self-employment income.
Privacy Act Statement Specifies the legal authority for collection of this information, its voluntary nature, the use of the information, and sharing under routine uses.

How to Fill Out Social Security Ssa 521

After deciding that withdrawing your Social Security application is in your best interest, the next step involves filling out the SSA-521 form properly. This process requires attention to detail and accuracy to ensure that your request is processed without delays. Here's a clear, step-by-step guide to help you complete the form.

  1. Start by entering the name of the wage earner, self-employed individual, or eligible individual at the top of the form.
  2. Next, provide the Social Security number of the individual mentioned. If you are filling this out on behalf of someone else and your name is different, make sure to print your name clearly in the designated area.
  3. Indicate your own Social Security number in the provided space if it hasn’t been mentioned yet.
  4. Under Type of Benefit, specify the benefit you are withdrawing your application for.
  5. Fill in the Date of Application to inform the SSA of when the original application was submitted.
  6. For those considering keeping their Medicare benefits, mark Yes or No in the section asking if you want to retain these benefits.
  7. Clearly state your reason(s) for withdrawing the application in the provided area. If you require more space, note that you can use the additional remarks section on the second page.
  8. Carefully read the declarations and understand the implications of withdrawing your application. Then, sign and date the form in ink.
  9. Provide your contact information, including your telephone number (with area code) and mailing address (with your city, state, and ZIP Code).
  10. If you’re signing by mark (X), ensure that two witnesses co-sign the form, providing their full addresses for validation.

After completing and verifying the details on the SSA-521 form, the final step involves sending or personally delivering the form to your local Social Security office. You can locate the nearest office by visiting the Social Security Administration's website or referring to your local telephone directory. Ensuring accuracy and completeness in your application can significantly smoothen the withdrawal process, allowing you to reconsider your Social Security benefits options without unnecessary hurdles.

More About Social Security Ssa 521

  1. What is Form SSA-521?

    Form SSA-521, officially titled "Request for Withdrawal of Application," is a document used by the Social Security Administration (SSA). This form allows individuals to withdraw their previously submitted Social Security application. When approved, the decision made on the initial application will not have any legal effect. This means that any rights, including appeal rights tied to the original application, will be forfeited. Individuals must repay any benefits already received. It's a step to consider if the initial decision to apply has or will likely result in a disadvantage.

  2. Why would someone want to withdraw their Social Security application?

    There are several reasons someone might choose to withdraw their Social Security application. Common reasons include the individual's decision to continue working or a change in financial circumstances. By withdrawing an application, an individual can potentially receive higher benefits later on. This form is particularly useful for those who feel that their original application was filed prematurely or without consideration of future ramifications.

  3. How does one withdraw their Social Security application?

    • Complete Form SSA-521 in detail, including the reason for withdrawal.
    • Submit the completed form to the local Social Security office.
    • Repay any benefits received based on the original application.
    • Obtain consent from any other person whose benefits might be affected by the withdrawal.

    It is crucial to understand that this request can't be canceled after 60 days from the mailing of the approval notice from SSA.

  4. Can I keep my Medicare benefits if I withdraw my Social Security application?

    Yes, it is possible to keep Medicare benefits even after withdrawing a Social Security application. On Form SSA-521, there is a specific question that asks if you wish to retain Medicare benefits. This option provides flexibility for those who still need medical insurance coverage but have decided to delay their Social Security benefits.

  5. What happens after withdrawing a Social Security application?

    After withdrawing a Social Security application:

    • The original application decision will have no legal effect.
    • All benefits paid out must be repaid.
    • Any rights to appeal the original decision will be lost.
    • You are free to reapply for Social Security benefits in the future, but keep in mind that the terms of your new application may differ, especially concerning retroactive benefits.

    This step essentially resets the applicant's status with the Social Security Administration, allowing for a fresh start or a reevaluation of when to begin receiving benefits.

Common mistakes

Filling out the Social Security SSA 521 form, which is a request for withdrawal of application, is a crucial process that impacts one's retirement benefits. However, individuals often make mistakes when completing this form, potentially leading to negative consequences regarding their Social Security benefits. Here are eight common errors to avoid:

  1. Not fully understanding the implications of withdrawal: Applicants sometimes fail to grasp that withdrawing their Social Security application can result in the forfeiture of any benefits already paid out and require repayment of received benefits.
  2. Incorrect personal information: Entering wrong personal details such as the social security number, name, or address can cause significant delays and issues in processing the withdrawal request.
  3. Failure to explain the reason for withdrawal accurately: The form requires a clear explanation for why the withdrawal is being requested. Vague or incomplete reasons can lead to unnecessary scrutiny or even rejection of the request.
  4. Omitting the date of the original application: Forgetting to include the date of the initial application can lead to processing delays, as this information is crucial for locating and reviewing your records.
  5. Not indicating whether you want to keep Medicare benefits: Applicants sometimes overlook the section where they must specify if they wish to maintain Medicare benefits, despite withdrawing the Social Security application.
  6. Forgetting to sign and date the form: An unsigned or undated form is considered incomplete and will not be processed until corrected, which can delay the withdrawal process.
  7. Not providing repayment information for benefits received: If benefits have been paid out based on the application being withdrawn, failing to provide information on how these will be repaid can complicate the withdrawal process.
  8. Ignoring the need for witness signatures if signed by mark (X): If the request is signed with an "X", it is mandatory to have two witnesses sign the form, acknowledging they know the person making the request. Overlooking this requirement can invalidate the request.

Awareness and careful avoidance of these mistakes can facilitate a smoother and quicker process in withdrawing a Social Security application through form SSA-521.

Documents used along the form

When submitting a Request for Withdrawal of Application using Form SSA-521 to the Social Security Administration, individuals might need to accompany this form with additional documents to ensure a smooth process or to comply with specific requirements. These documents vary based on the individual's situation and the type of benefit they are withdrawing from. Understanding these documents can help streamline the withdrawal request and ensure all necessary information is provided.

  • Birth Certificate: This document is often required to verify the identity and age of the individual making the withdrawal request, especially if the application being withdrawn pertains to retirement or disability benefits.
  • Proof of U.S. Citizenship or Lawful Alien Status: Documentation such as a U.S. passport, naturalization certificate, or alien registration card may be needed to confirm eligibility for Social Security benefits, particularly if citizenship or immigration status was relevant to the initial benefit application.
  • W-2 Forms or Self-employment Tax Returns: Recent tax documents may be required if the withdrawal request is related to earnings records or to verify income information provided in the original application.
  • Medical Records: If the withdrawal request involves disability benefits, relevant medical records that were part of the initial application may need to be resubmitted or updated.
  • Marriage Certificate or Divorce Decree: For benefits that were based on a spouse's earning records, documents confirming marital status can be crucial to processing a withdrawal request.
  • Proof of Representation: If another individual is acting on behalf of the person making the withdrawal request, documentation authorizing this representation, such as a power of attorney, may be necessary.

Navigating the process of withdrawing a Social Security application can be complex, and providing comprehensive documentation is key to a successful request. Ensuring that all relevant forms and documents accompany Form SSA-521 can help avoid delays and ensure that the Social Security Administration has all the necessary information to process the withdrawal appropriately.

Similar forms

The Social Security SSA 521 form, Request for Withdrawal of Application, is a unique document but shares similarities with other forms in its purpose and implications for the individual. These documents primarily involve requesting changes to previously submitted information or benefits with significant consequences. Understanding these similarities helps individuals navigate their options carefully.

  • IRS Form 1040-X (Amended U.S. Individual Income Tax Return): Similar to the SSA 521 form, the IRS 1040-X allows individuals to amend a previously filed tax return. Both forms serve to correct or update initial filings, possibly affecting an individual's financial standing significantly. While the SSA 521 deals with Social Security benefits, the 1040-X addresses tax liabilities and refunds.

  • USCIS Form I-90 (Application to Replace Permanent Resident Card): This form is used to request a new Green Card if the previous one is lost, stolen, or damaged. Like the SSA 521, the I-90 involves the submission of a request related to previously conferred benefits or status, with both requiring precise information and occasionally resulting in substantial changes to the applicant's legal or social standings.

  • VA Form 21-526EZ (Application for Disability Compensation and Related Compensation Benefits): Veterans use this form to initiate or update a claim for disability benefits. Similar to the SSA 521 form, submitting this document can lead to significant changes in an individual's benefits. Both forms require detailed personal information and impact the applicant's future entitlements and financial benefits.

  • HUD-1 Settlement Statement: Although not a form submitted to request changes, the HUD-1 Settlement Statement is crucial in real estate transactions, serving to itemize buyer and seller closing costs. Like the SSA 521, it finalizes an important process (in this case, property purchase) and affects financial responsibilities and rights. Both documents ensure parties are fully informed about the implications of the transactions and agreements they enter into.

All these documents, including the SSA 521 form, play pivotal roles in their respective areas, influencing individuals' financial or social status based on the adjustments they request. Understanding the purpose and implications of each helps in making informed decisions.

Dos and Don'ts

When you're getting ready to fill out the Social Security SSA-521 form, there are several important steps to follow and mistakes to avoid. Understanding these can help ensure that your request to withdraw your application is processed smoothly. Here's a helpful guide:

Things You Should Do:

  • Read the instructions carefully: Before you start filling out the form, make sure to thoroughly understand the instructions provided. This ensures you accurately complete the form and know what documents you might need to attach.

  • Provide a clear reason for withdrawal: Be specific about why you want to withdraw your application. If the space provided on the form isn’t enough, use the additional remarks section for a more detailed explanation.

  • Keep a copy for your records: After completing the form, but before sending it to the Social Security office, make a copy for your personal records. This helps you have a reference of what was submitted, just in case there are any questions or issues later on.

  • Verify all personal information: Double-check your Social Security number, address, and other personal details to ensure they're accurate. Mistakes here could delay processing.

Things You Shouldn't Do:

  • Fill out the form in haste: Take your time to ensure all the information you provide is accurate and complete. Rushing could lead to errors or omissions.

  • Forget to include required signatures: Your signature is required to process the form. If the form is signed with a mark (X), remember, two witnesses are needed, and they must also sign the form.

  • Leave sections blank: If a question or section does not apply to you, write ‘N/A’ (not applicable) instead of leaving it blank. This shows the reviewer that you did not simply overlook the question.

  • Delay sending the completed form: Once you have filled out the form and checked everything, send it to your local Social Security office as soon as possible. Waiting too long could affect your ability to withdraw your application.

Misconceptions

There are quite a few misunderstandings floating around about the Social Security SSA-521 form. Let's clear some of them up:

  • It's too complicated to withdraw an application. While the form does require detailed information, the process is designed to protect individuals by ensuring they fully understand the implications of withdrawing their Social Security application.

  • Once you submit SSA-521, the decision is instant. Approval isn't immediate. The Social Security Administration (SSA) reviews each request thoroughly before making a decision, which may take some time.

  • There's no option to keep Medicare benefits if you withdraw your Social Security application. The form clearly asks if you wish to keep Medicare benefits, indicating that retaining these benefits is indeed an option.

  • Submitting Form SSA-521 negatively affects your earnings record. The form states that withdrawing your application will not affect the proper crediting of wages or self-employment income to your Social Security earnings record.

  • There's no consideration given for those who continue working. In fact, one of the reasons for withdrawal listed directly refers to applicants who intend to continue working and have been advised of the alternatives.

  • You can't cancel the withdrawal request once it's made. You actually have 60 days from the mail date of the notice of approval to cancel your withdrawal request.

  • Filing Form SSA-521 is an admission of false information. This form is simply a request to withdraw a previous application for benefits, not an admission of providing false information. It is there for those who believe withdrawing their application is in their best interest.

  • Everyone linked to the application must consent to its withdrawal. If a determination of your entitlement has been made, all benefits paid out based on the application you want withdrawn need to be repaid, and all other persons whose benefits would be affected must consent to this withdrawal. This is to ensure that no one affected by the withdrawal is caught by surprise.

Understanding these points about Form SSA-521 can help dispel needless worries and guide you through the process more smoothly.

Key takeaways

Filling out and using the Social Security SSA-521 form, formally known as the Request for Withdrawal of Application, is a process that allows individuals to cancel their previously filed application for Social Security benefits. This action is not to be taken lightly as it carries significant implications regarding one's benefits and rights. Here are four key takeaways about this form and its usage:

  • Repayment of Benefits: If an individual's request to withdraw their Social Security application is approved, they are required to repay any benefits received from that application. This includes any payments made to third parties on the basis of the withdrawn application. It's essential to consider the financial implications before deciding to withdraw an application.
  • One-Time Decision: Once the Social Security Administration approves the withdrawal request, this action cannot be canceled after 60 days from the mailing of the notice of approval. This makes it crucial for individuals to be certain of their decision to withdraw, considering it’s a one-time action with permanent effects on the benefits initially applied for.
  • Subsequent Applications: Withdrawing an application means forfeiting rights attached to it, including the rights of appeal. Should an individual decide to reapply for Social Security benefits in the future, the new application cannot cover the same retroactive period as the withdrawn application. This could significantly impact the timing and amount of future benefits.
  • Consent and Repayment Requirements: For the withdrawal to be processed, not only must the individual wanting to withdraw their application repay all benefits received, but all other individuals whose benefits would be affected by the withdrawal must also consent to it. This ensures that all parties are aware of and agree to the withdrawal and its consequences.

Understanding the rules and implications related to the SSA-521 form is critical for those considering withdrawing their Social Security application. Careful consideration and a clear grasp of the future financial landscape are advised before proceeding with a withdrawal request.

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