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USSSARev. 01-2024

Official form guide

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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Form Overview

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.

A request to withdraw your application as if it was never filed, allowing you to reapply at a later date.

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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Glossary Terms

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Field map

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7 fields

Applicant Info

3 items

Name

Your full name as shown on your Social Security card.

Requiredtext
Social Security Number

Your SSN.

Requiredssn
Date of Birth

Your date of birth.

Requireddate

Withdrawal

2 items

Type of Benefit to Withdraw

Indicate which application you want to withdraw (retirement, disability, Medicare, etc.).

Requiredselect
Reason for Withdrawal

Brief explanation of why you want to withdraw your application.

Requiredtext

Signature

2 items

Signature

Your signature confirming the withdrawal request.

Requiredsignature
Date

Date you signed the form.

Requireddate

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Quick Facts

Applicants who want to cancel a Social Security or Medicare application before benefits begin, or within 12 months of becoming entitled.
A request to withdraw your application as if it was never filed, allowing you to reapply at a later date.
Must be submitted within 12 months of the date your entitlement began. All received benefits must be repaid.
Submit to your local Social Security office.
Withdrawing allows you to delay claiming benefits to a later date when your monthly benefit amount may be higher.
Complete the form with your personal information and reason for withdrawal. If benefits were received, arrange repayment before or with the form.

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Copyright & Licensing - US Government Forms

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Public DomainCreated by the U.S. federal government. Not subject to copyright (17 USC § 105). Freely copyable without restriction.
Public DomainCreated by the U.S. federal government. Not subject to copyright (17 USC § 105). Freely copyable without restriction.
Public DomainCreated by the U.S. federal government. Not subject to copyright (17 USC § 105). Freely copyable without restriction.
Public DomainCreated by the U.S. federal government. Not subject to copyright (17 USC § 105). Freely copyable without restriction.
Verify current license terms with the source agency before reuse outside this platform.

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