Get Ssa-521 2012-2025

The SSA-521 form is a request for withdrawal of an application for Social Security benefits. This guide provides user-friendly, step-by-step instructions to assist you in completing the form accurately and effectively online.

Follow the steps to fill out the SSA-521 form online.

1. Press the ‘Get Form’ button to access the SSA-521 form and open it for editing.
2. Begin by entering the name of the wage earner, self-employed individual, or eligible individual in the designated field.
3. Input the Social Security number associated with the individual named in the previous field.
4. If the name differs from your own, print your first name, middle initial, and last name in the provided field.
5. Fill in your Social Security number in the next section.
6. Select the type of benefit you wish to withdraw from the list provided.
7. Indicate whether you want to retain Medicare benefits by selecting 'Yes' or 'No.'
8. Provide the date of your original application in the appropriate format.
9. In the section requesting the reason for withdrawal, clearly state your reason. If more space is required, use the reverse side of the form.
10. Sign the request in the designated area, ensuring you write your name in ink.
11. Enter the date of the signature in the specified format.
12. Include your telephone number, making sure to include the area code.
13. Provide your mailing address, including the number and street, apartment number, or P.O. Box, followed by your city, state, and ZIP code.
14. If applicable, list the name of the county where you currently reside.
15. If your signature was marked (X), provide witness signatures and their addresses in the specified fields.
16. Review all information for accuracy before finalizing your submission.
17. Once completed, you can save changes, download, print, or share the SSA-521 form.

Start completing your SSA-521 form online today to take the next step in managing your Social Security benefits.