Form SSA-770-U4 - May 2016

Form SSA-770-U4 is used to request the withdrawal of an application for retirement, spouse's, Medicare or disability benefits. Individuals who have applied for Social Security benefits and want to request the withdrawal of their application can safely fill and sign this form online with Lumin. The completed form should be submitted to the local Social Security office.

Individuals who have applied for Social Security benefits and want to request the withdrawal of their application.

The completed Form SSA-770-U4 should be submitted to the local Social Security office.