Form 06 005 2026

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The document is a request form for the withdrawal of a Social Security application. It outlines the implications of withdrawing the application, including the forfeiture of rights to reconsideration and appeal, potential repayment of benefits, and the requirement for consent from affected parties. The form also emphasizes that the withdrawal will not affect the crediting of wages to the individual's Social Security earnings record.

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Click ‘Get Form’ to open it in the editor.
Begin by entering your full name in the designated field, including your first name, middle initial, and last name.
Select the type of benefit you are withdrawing from the dropdown menu provided.
Fill in the date of your application and your Social Security number accurately.
In the signature section, sign your name as required. If you are signing by mark (X), ensure two witnesses sign below.
Provide a mailing address where you can be reached, including street number, city, state, and ZIP code.
Lastly, give a reason for your withdrawal in the space provided. If more space is needed, utilize the reverse side of the form.

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