Social Security Administration (SSA) Edition Form SSA-521 (07-2026) UF (OMB No. 0960-0015); discontinue prior editions 2 pages

Form SSA-521 — Request for Withdrawal of Application

Undo a Social Security benefit application, as if it had never been filed, by repaying what was paid on it.

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Form SSA-521 · Request for Withdrawal of Application
The official Social Security Administration (SSA) form, edition Form SSA-521 (07-2026) UF (OMB No. 0960-0015); discontinue prior editions — blank
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Form SSA-521 (2026) Request for Withdrawal of Application — page 1 of 2
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Form SSA-521 (2026) Request for Withdrawal of Application — page 2 of 2
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Fill this form online Blank PDF from Social Security Administration (SSA)

What is Form SSA-521?

Form SSA-521 asks the Social Security Administration to withdraw an application for benefits. If SSA approves the request, its decision on that application has no legal effect: it's as if you never applied. People use it, for example, when they claimed retirement benefits early and then decide to keep working or wait to claim a larger benefit later.

The form's notice spells out what that costs. You give up all rights attached to the application, including appeal rights, and must repay every benefit paid to you or to anyone else on that application. Everyone whose benefits would be affected must consent. You must reapply later if you want benefits, and a later application may not cover the same retroactive period. The request can't be canceled more than 60 days after the notice of approval is mailed.

FileIt pre-fills the name from your vault, prints your answers onto SSA's own PDF (07-2026 edition) and saves it in your vault folder. The signature line says to write in ink, so you print it, sign it, and send or bring it to your local Social Security office yourself.

Who files
The person who applied for benefits (or the wage earner or eligible individual named on the application).
Repayment
All benefits paid on the application, to you or anyone else, must be repaid if entitlement was decided.
Signature
In ink, under penalty of perjury; two witnesses only if signed by mark (X).
Submit to
Your local Social Security office, by mail or in person.
Edition
Form SSA-521 (07-2026) UF, OMB No. 0960-0015; discontinue prior editions

Who needs to fill out Form SSA-521?

  • People who started Social Security retirement benefits and want to undo the claim, for example to keep working or to claim later.
  • Applicants who want to withdraw another kind of application, such as for spouse's or disability benefits, after talking to SSA about the effects.
  • People who want to keep or drop Medicare while withdrawing a benefit application.

When to use Form SSA-521

  • When you're sure the application has resulted, or will result, in a disadvantage to you, which is when the form says the procedure is intended to be used.
  • After talking with your local Social Security office, which the form says will explain whether and how the procedure will help you.
  • Applicants under full retirement age who intend to keep working confirm they've been advised of the alternatives to withdrawal.

What you need before you start

  • The name and Social Security number of the wage earner, self-employed or eligible individual, and yours if different.
  • The type of benefit you want to withdraw and the date you applied.
  • Whether you want to keep Medicare benefits, if that applies.
  • Your reason, your mailing address, phone number and county.

What’s on Form SSA-521

The 2026 edition has 2 pages. FileIt asks for it in 4 parts:

  1. Request for withdrawal of applicationPerson making the request
  2. Reason for withdrawalPerson making the request
  3. Signature of person making requestPerson making the request
  4. Witnesses (only if signed by mark)Person making the request

How to fill out Form SSA-521, step by step

1 Who and what

The name and SSN on the application (and your own if different), the type of benefit to withdraw, the application date, and whether you want to keep Medicare.

2 The request

The printed paragraph is your request and acknowledgement: no cancellation after 60 days from the approval notice, repayment of all benefits paid, consent of everyone affected, and the application stays in SSA's records without affecting your earnings record.

3 Reason for withdrawal

Tick 'I intend to continue working', or 'Other' and explain fully.

4 Signature and address

Sign in ink under penalty of perjury, date it, and give your phone number, mailing address and county. Witnesses sign only if you sign by mark.

Common mistakes to avoid

  • Filing without understanding that all benefits paid on the application must be repaid.
  • Forgetting that family members who receive benefits on your record must consent.
  • Waiting too long: the request can't be canceled after 60 days from the mailing of the approval notice.
  • Not answering the Medicare question when you want to keep Medicare.
  • Signing in pencil or typing the name instead of signing in ink.

After you fill it out

Print the form and sign it in ink.

Send or bring it to your local Social Security office.

Watch for SSA's decision and any repayment it requires. FileIt keeps the filled form in your vault folder.

Fill out Form SSA-521 online with FileIt

  1. Pick the person. Choose someone from People and FileIt fills in their name, date of birth, address and other details it already knows.
  2. Answer plain-language questions. One part of the form at a time, with the official help text beside each question — 20 fields in all. Your answers save as you go.
  3. Check the live preview. Watch your answers land on the real Social Security Administration (SSA) form, and let FileIt do any worksheet arithmetic.
  4. Generate the official PDF. FileIt prints your answers into the agency’s own PDF and files it in that person’s folder in your vault.

FileIt fills the form — it never files or submits anything for you. Deliver the finished form to whoever asked for it, the way the form’s instructions say.

Start Form SSA-521 now — it’s free

Form SSA-521: frequently asked questions

What happens if SSA approves my withdrawal?

The form says the decision SSA made on your application has no legal effect, you forfeit all rights attached to it including appeal rights, and you must return any payment made to you or anyone else on that application.

Can I change my mind after withdrawing?

The form says the request may not be canceled after 60 days from the mailing of the notice of approval.

Can I apply again later?

Yes, you must reapply if you want a determination later, but the form says a later application may not involve the same retroactive period.

Does withdrawing affect my earnings record?

No. The form says the withdrawal won't affect the crediting of wages or self-employment income to your earnings record.

Can I keep Medicare?

The form asks, if applicable, whether you want to keep Medicare benefits. Tick Yes or No.

Can I sign it electronically?

No. The signature line says to write in ink.

Official sources

FileIt is not affiliated with or endorsed by Social Security Administration (SSA) or any government. This page explains the form in general terms and is not legal, tax or immigration advice. Always read the official instructions, and check that you are using the edition the recipient accepts. Page last reviewed 2026-10-01.

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