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§ 422.515 Forms used for withdrawal, reconsideration and other appeals, and appointment of representative. ... SSA-521 - Request for Withdrawal of Application. ( ...
Fill out Social Security Form SSA-521. Include the reason why you want to withdraw the application on the form. If you already have Medicare, your request ...
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 cancelled