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Form SSA-521: Request for Withdrawal of Application
Withdraws a Social Security or Medicare benefit application before any benefits are paid. Must be submitted within 12 months of the original application and all benefits received must be repaid.
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SSA Form SSA-521 - Request for Withdrawal of Application
Withdraws a Social Security or Medicare benefit application before any benefits are paid. Must be submitted within 12 months of the original application and all benefits received must be repaid.
Risk Radar
Scan points- 1Missing the 12-month window — withdrawals are not allowed after 12 months from entitlement.
- 2Not repaying all benefits received — SSA will not process the withdrawal until all benefits are repaid.
- 3Not understanding the impact on family members who may also receive benefits on your record.
Plain English
Use this form to cancel a Social Security or Medicare application you filed — for example, if you changed your mind about when to start collecting benefits.
Submission Date
- Filing date: Must be submitted within 12 months of the date your entitlement began. All received benefits must be repaid.
- Preparation window: collect IDs, supporting records, and signatures in advance.
- Final review: verify names, dates, and required fields before submission.
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Field map
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Applicant Info
3 items
Your full name as shown on your Social Security card.
Your SSN.
Your date of birth.
Withdrawal
2 items
Indicate which application you want to withdraw (retirement, disability, Medicare, etc.).
Brief explanation of why you want to withdraw your application.
Signature
2 items
Your signature confirming the withdrawal request.
Date you signed the form.
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Questions about SSA Form SSA-521
What is SSA Form SSA-521 used for?
Use this form to cancel a Social Security or Medicare application you filed — for example, if you changed your mind about when to start collecting benefits.
Who must file SSA Form SSA-521?
Applicants who want to cancel a Social Security or Medicare application before benefits begin, or within 12 months of becoming entitled.
What information does SSA Form SSA-521 require?
A request to withdraw your application as if it was never filed, allowing you to reapply at a later date.
When is SSA Form SSA-521 due?
Must be submitted within 12 months of the date your entitlement began. All received benefits must be repaid.
Where do I file SSA Form SSA-521?
Submit to your local Social Security office.
How do I complete SSA Form SSA-521?
Complete the form with your personal information and reason for withdrawal. If benefits were received, arrange repayment before or with the form.
What happens if SSA Form SSA-521 is filed incorrectly?
Withdrawing allows you to delay claiming benefits to a later date when your monthly benefit amount may be higher.
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