TN 1 (11-00)

A. Policy

1. Written Request Filed with SSA

A written request for withdrawal of an SVB application must be signed and filed with SSA in order for a withdrawal to be processed. Oral withdrawal requests cannot be accepted. A signed request for withdrawal must be obtained in order for a withdrawal to be processed.

a. Who Must Sign Request

The claimant or another person who would be a proper applicant must sign the request. See VB 00201.015 for a description of a proper applicant.

b. Meaning of "Filed with SSA"

A withdrawal request is considered filed with SSA when it is filed at a Social Security office, a Federal Benefits Unit.

c. Definition of Filing Date

Generally, a withdrawal request is considered filed on the day it is received. However, the U.S. or foreign postmark date may be used as the filing date if using the date the withdrawal request is received would result in a loss of payments or rights. If the postmark is unreadable or missing, use the date the request is signed or five days before the day it was received, whichever is later.

d. No Time Limit on Filing

There is no time limit on when a request for withdrawal may be filed, but the date the withdrawal is filed could be material in determining whether other conditions for approving the withdrawal are met (see VB 00201.070A.3. and VB 00201.070A.4.)

e. Form Retention

A request for withdrawal and other related documents will be retained by SSA as part of the claims file. Do not return these documents to the claimant.

2. Necessary Elements of Request

a. Identification of the Application

The withdrawal request must show the specific application being withdrawn including the:

• date claim filed, and

• specific class of benefit(s) being withdrawn.

For example, the withdrawal request should specify “the application for SVB filed on April 3, 2000”.

b. Reason for Withdrawal

The request must state the reason why the application is being withdrawn.

c. Effects of Withdrawal — Withdrawal Not Disadvantageous

Explain the full effects of the withdrawal to the claimant. The claimant's (or proper applicant's) signature on the written withdrawal request is sufficient to indicate that the effects of the withdrawal are understood.

d. Effects of Withdrawal — Withdrawal Is Disadvantageous

If the withdrawal is clearly disadvantageous, the claimant's signed statement must contain a detailed description of the effects of the withdrawal. If this part of the statement is not obtained, the withdrawal can be approved if the file contains an explanation why it was not obtained and documentation of the explanation of the disadvantages including repayment that was given.

If a clearly disadvantageous withdrawal is requested by a proper applicant on behalf of a claimant, and he or she insists on withdrawing after receiving all necessary explanations, fully document the explanation of the condition which makes the withdrawal disadvantageous over the proper applicant's signature.

e. The Advantages of Disallowance Over Withdrawal

A disallowance of SVB is preferable to a withdrawal. If the claimant insists on withdrawing the SVB claim and a disallowance would serve the same purpose (e.g., “failure to pursue claim”), obtain a signed statement from the individual stating that the claimant (or proper applicant) understands:

• That there is no need to withdraw the claim;

• That a disallowance notice preserves the claimant's appeal rights whereas a withdrawal does not; and

• That a subsequent SVB application will not be effective for the same period.

If the required signed statement for withdrawal is not obtained, document the claim with the pertinent facts and disallow the claim. The withdrawal will not be processed.

f. Explanation of Conditional Withdrawal

If the individual's desire for a withdrawal is based on the expected outcome of another event, i.e., the withdrawal is conditional, the request must contain an explicit explanation of the condition.

3. Claimant Must Be Alive

The claimant must be alive at the time of filing the request.

4. Request Filed After SVB Determination Is Made and Benefits Paid

If the request for withdrawal is filed after a determination has been made on the application, in addition to meeting requirements in VB 00201.070A.1. through VB 00201.070A.3., all benefits already paid on the application must be repaid before the withdrawal can be approved. Repayments are requested in U.S. currency, however, foreign currency will be accepted (see GN 02215.005). Accept repayment in the form of cash, money order, cashier's check, certified or uncertified check. Discourage the use of cash especially when the payment is to be mailed. Inform the individual that he or she is responsible for payments lost in the mail.

B. Procedure

There is no particular form for requesting a withdrawal of an SVB application.

1. Request Prepared by the Individual

If the individual submits a written request containing all of the elements described in VB 00201.070A.2., do not request anything further.

2. Request Prepared by SSA Representative

If SSA personnel have the opportunity to prepare a document for the individual's signature, prepare it on an SSA-795 (Statement of Claimant or Other Person).