VA Form 5655, the Financial Status Report, shows VA your income, expenses, assets and debts when you request certain debt-relief or repayment options. The report supports your request. You also need to make clear whether you want a waiver, a compromise or a payment plan.

Download the current VA Form 5655 PDF

Download the official January 2024 VA Form 5655 PDF, linked from VA's form page. I checked both pages on October 2, 2026. The footer reads JAN 2024 (RS), and the form has Items 1 through 38 across eight sections.

Gather your debt letter, recent income information, monthly bills, account balances and installment-debt information before starting. If married, the form also asks about your spouse's finances. Keeping income, monthly payments and total balances separate makes the arithmetic much easier to check.

Who files it, and for what kind of request?

VA's Financial Status Report guidance identifies three uses: a waiver, a compromise offer and an extended repayment plan.

  • Waiver: You ask VA to forgive the debt.
  • Compromise: You offer a smaller amount as full payment.
  • Payment plan: You ask to repay over time.

An overpayment means VA paid more benefits than the recipient was entitled to receive. If you believe the debt itself is wrong, a dispute is a different request from asking VA to forgive an otherwise valid debt. VA's debt-options page explains both routes.

For benefit overpayments, that page says a waiver request is due within one year after receiving the first debt letter. It separately says disputing an overpayment within 30 days can avoid collection actions. Read your letter promptly; those time periods serve different purposes.

VA's pages are inconsistent at the exact five-year repayment boundary. The Financial Status Report guide says “more than 5 years,” while the newer debt-options page's instructions say “5 or more years.” For a proposed plan of exactly five years, confirm whether VA needs 5655 by calling 800-827-0648. Longer plans require the report under both pages.

Items 1 through 3: Identify yourself and the request

Item 1 asks for your Social Security number. Item 2 asks for the VA file number. VA says the file number and deduction code appear on the debt letter and payment stub. Copy the applicable information from the actual notice.

Item 3 asks why you are completing the report. State waiver, compromise, payment plan or another specific purpose. A balanced worksheet without an identified request leaves VA without the explanation this field requires.

For a waiver or compromise, VA's submission instructions also require a personal statement. Explain why you believe you should not repay the debt, or why VA should accept the proposed lower amount. For a compromise, state the one-time amount offered. Online, there is space for the statement; on paper, include a separate letter.

Section I: Personal details and employment, Items 4 through 12

  • Item 4: Your first, middle and last name.
  • Item 5: Mailing address.
  • Item 6: Telephone number with area code.
  • Item 7: Birth date in month-day-year format.
  • Item 8: Married or not married.
  • Item 9: Spouse's name, if applicable.
  • Item 10: Ages of other dependents.
  • Item 11: Your employment during the past two years, including job type, beginning and ending dates, and employer name and address.
  • Item 12: The same employment history for your spouse.

Describe the actual employment history, including changes. If you lost a job recently, do not present the former paycheck as your current regular income without explanation. Item 36 provides room for context and continuation entries.

VA uses the spouse's information to understand household finances. If separation or another circumstance makes the requested information difficult to provide, explain the situation and ask VA how to complete it; do not invent amounts.

Section II: Monthly income, Items 13 through 17

This section has separate self and spouse columns. Use average monthly amounts, not annual totals or a mixture of weekly and monthly figures.

Item 13: Gross monthly salary before payroll deductions.

Items 14A through 14D: Income taxes, retirement deductions, Social Security deductions and other identified payroll deductions. 14E is the total of those deductions.

Item 15: Net take-home pay, calculated by subtracting 14E from 13. Do not enter take-home pay in Item 13 and subtract the same deductions again.

Item 16: VA benefits, Social Security benefits and other income, with the source identified. A payroll Social Security deduction in 14C is different from a Social Security benefit received here.

Item 17: Total monthly net income, adding Items 15 and 16 for each applicable column.

For irregular earnings, VA says to estimate the average monthly amount as accurately as possible. Its guidance permits dividing last year's reported wages by 12 when appropriate. Explain a major current change in Item 36 so an old average does not conceal a recent loss of income.

Section III: Monthly expenses, Items 18 through 23

Item 18 is rent or mortgage. Item 19 is food. Item 20 is utilities and heat. Item 21 is other living expenses, which VA's guidance says can include transportation, clothing, child care and health care.

Item 22 carries the total monthly installment and other debt payments from Section VI, Item 34I, column E. Enter monthly payments here, not the entire unpaid balances.

Item 23 totals monthly expenses. Check that every amount uses the same monthly period and that an expense appears only once in the total.

VA allows reasonable estimates for expenses that vary. You can use the latest bill or divide a year's expenses by 12, depending on the expense. Annual costs can also be converted to monthly amounts. VA says you do not ordinarily need to send bills or receipts with the initial request, although it may ask for more information during review.

Section IV: Money remaining, Items 24A and 24B

Item 24A is net monthly income less expenses: Item 17 minus Item 23. When both income columns apply, include the household's applicable net income in that comparison.

Item 24B asks how much you can pay toward the debt each month. Report a realistic amount supported by the finances you provided. It is a proposed ability-to-pay figure, not an approved payment agreement.

If 24A and your proposed payment need explanation, use Item 36. A negative result should not be turned into a positive number to make the application look easier to approve.

Section V: Assets, Items 25 through 33

Report the assets requested by the current form:

  • 25: Cash in bank accounts.
  • 26: Cash on hand.
  • 27: Automobiles, with make, year, model and resale value.
  • 28: Trailers, boats and campers at resale value.
  • 29: Current value of U.S. savings bonds.
  • 30: Current value of stocks and other bonds.
  • 31: Resale value of real estate owned.
  • 32: Other identified assets.
  • 33: Total assets.

VA says estimated resale values are acceptable. Use what you reasonably expect the item could sell for in your community, supported by available price information. Do not substitute the original purchase price just because you have that receipt. The form separately asks about debt balances, so keep an asset's stated value and the debt associated with it understandable.

Section VI: Installment debts, Item 34

Rows 34A through 34H list debts paid in installments. Each row has six columns:

  • A: Creditor's name and address.
  • B: Date and purpose of the debt.
  • C: Original amount borrowed or owed.
  • D: Current unpaid balance.
  • E: Amount due monthly.
  • F: Amount past due, if any.

Item 34I totals the amount columns. Transfer its column E total to Item 22. The form specifically says not to include living expenses in this section, so do not count the same housing or other living expense twice.

If repayment is not monthly, the printed instruction says to enter zero in column E and describe the arrangement in Item 36. Use that explanation instead of converting an unusual agreement into a fictitious monthly obligation.

Sections VII and VIII: Additional data and signatures

Item 35A asks whether you have ever been adjudicated bankrupt. If yes, complete 35B with the discharge date, 35C with the court location and 35D with the docket number if known. If VA or a mortgage company was involved, the form asks for pertinent documentation.

Item 36 is for explanations and continuation answers. Label each explanation with its item number. This is a useful place to explain irregular income, a recent change or a repayment arrangement that is not monthly.

Items 37A and 37B are your required signature and date. Items 38A and 38B are your spouse's signature and date when applicable. Review both pages before signing. The certifications warn against knowingly false statements or evidence.

Fictional example: Check the monthly arithmetic

This is a fictional budget exercise, not a real household, a VA benefit-rate example or a recommended repayment offer. Assume an unmarried applicant with the following monthly entries:

  • 13: Gross wages of $3,000.
  • 14E: Total payroll deductions of $600.
  • 15: Take-home wages of $2,400.
  • 16: Other identified income of $600.
  • 17: Total net income of $3,000.
  • 18 through 21: Rent $1,200, food $450, utilities $200 and other living expenses $650.
  • 34I, column E, carried to 22: Installment payments totaling $350.
  • 23: Total expenses of $2,850.
  • 24A: $150 remaining after expenses.

Those figures demonstrate the form's calculations. They do not decide Item 24B for the applicant. The applicant must state an affordable proposal, explain relevant circumstances and still complete the assets, debts, request purpose and signature fields.

If a dependency change contributed to the debt, Claim Raven's VA disability calculator can help you compare compensation estimates for different dependent situations without an account. Use your actual benefit and payment records for Item 16; a calculator estimate is not evidence of what you received or what VA withheld.

Where to submit the report

For disability compensation, pension or education overpayments, VA's submission guide gives these options:

  • Online: Use the Financial Status Report application linked from VA's 5655 page, including the requested statement.
  • Mail: U.S. Department of Veterans Affairs, Debt Management Center, PO Box 11930, St. Paul, MN 55111. Include the signed report and required separate statement.

VA's newer debt-options page gives spouses and dependents a paper-and-mail route for waiver, compromise and extended-plan reports. Follow the route available for your relationship to the debt.

For health care copay waiver or compromise requests, that page offers online submission and also directs paper materials to the business or health administration office at your nearest VA medical center. Use VA's location finder for the local address.

A routine copay payment plan has a different form and destination: the current debt-options page identifies 10-323 and the Consolidated Patient Account Center. Do not send every copay payment-plan request to the benefits Debt Management Center.

Fax: The current 5655 submission guide does not specify a dedicated fax route. Use its online or mail instructions, or confirm a fax destination with the office handling your debt before sending financial information. An old contact number is not enough to establish the correct submission route.

After submission and final checks

VA's debt-management guidance says VA reviews the request and mails its decision, payment instructions and information about appealing. If requested as part of a waiver, VA also schedules an oral hearing. A submitted report alone does not prove the requested relief was granted.

Keep the report, statement and receipt. Recheck the totals, spouse information, installment-payment transfer and signatures before sending. Submit a new report if your finances change, as VA's instructions require. Contact the debt office about collection questions rather than assuming your proposed payment is already in effect.

A dependency change may also require 21-686c. Updating the dependent record and resolving an existing debt are separate tasks. For help appointing a representative, see 21-22 and 21-22a.

Verified October 2, 2026: the official January 2024 two-page PDF, form page, submission guide, debt-options page and debt-management guidance. The PDF's printed OMB expiration is November 30, 2026. The five-year wording conflict and unverified dedicated fax route are identified above. All example amounts are fictional.

Where to go next

Claim Raven is data analysis, not legal, medical, or VA-accredited advice. Consult VA's debt office or an accredited representative about your debt, request and deadlines.

-Landon Founder, Claim Raven | U.S. Army Veteran