Financial Status Report

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0165 can be found here:

Documents and Forms

Document Name Document Type
Form 5655 Financial Status Report Form
5655 Financial Status Report VA5655.pdf www1.va.gov/debtman Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Financial Status Report	Agency IC Tracking Number:	2900-0165

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 38 CFR 1.931 38 CFR 1.982 38 CFR 1.983 38 CFR 1.941 38 CFR 1.942 38 CFR 1.965 38 CFR 1.912 38 CFR 1.917

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	5655	Financial Status Report	VA5655.pdf	http://www1.va.gov/debtman	Yes	No	Fillable Fileable

Line of Business: General Government

Subfunction: Legislative Functions

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 116,151	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	116,151	20,581	95,570
Annual IC Time Burden (Hours)	116,151	20,581	95,570
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.