Financial Status Report

Forms and Documents

Document Name	Status
Form 5655 Financial Status Report Form	Removed
Form 5655 Financial Status Report Form	New
FSR 2900-0165 30 Day FRN Published.pdf Supplementary Document	2023-09-29
Supporting Statement Part A (2900-0165 FSR VA Form 5655 sept23).docx Supporting Statement A	2023-09-07
60 Day FRN Published (Monday 071023 Vol. 88 No. 130 FRN Page 43651)(FSR).pdf Supplementary Document	2023-07-11

IC Document Collections

IC ID	Document Title	Status
44123	Financial Status Report Form	Removed
260945	Financial Status Report Form	New

ICR Details

OMB Control No: 2900-0165	ICR Reference No: 202306-2900-026
Status: Received in OIRA	Previous ICR Reference No: 201911-2900-007
Agency/Subagency: VA	Agency Tracking No: 2900-0165
Title: Financial Status Report
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 09/29/2023

	Requested	Previously Approved
Expiration Date	36 Months From Approved	10/31/2023
Responses	33,335	116,151
Time Burden (Hours)	33,335	116,151
Cost Burden (Dollars)	0	0

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Abstract: The major use of the form is to document and support eligibility determinations for waivers of collection, for the consideration of compromise offers, or to document information to assist in developing repayment plans.

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Authorizing Statute(s): US Code: 5 USC 5514 Name of Law: Installment deduction for indebtedness to the United States
   US Code: 38 USC 5302 Name of Law: Waiver of recovery of claims by the United States
   US Code: 38 USC 5314 Name of Law: Indebtedness offsets
   US Code: 31 USC 3711 Name of Law: Collection and compromise
   US Code: 38 USC 3716 Name of Law: Administrative offset
   US Code: 38 USC 3717 Name of Law: Interest and penalty on claims
   US Code: 38 USC 3718 Name of Law: Contracts for collection services
   US Code: 38 USC 5316 Name of Law: Authority to sue to collect certain debts
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	88 FR 43651	07/10/2023
30-day Notice:	Federal Register Citation:	Citation Date:
	88 FR 67452	09/29/2023
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Financial Status Report	5655	Financial Status Report
Financial Status Report	5655	Financial Status Report

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ICR Summary of Burden

	Total Request	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	33,335	116,151	0	-82,816	0	0
Annual Time Burden (Hours)	33,335	116,151	0	-82,816	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: During the Coronavirus 2019 (COVID-19) Pandemic, collection was paused on new debts effective April 2020 at the Debt Management Center (DMC) and restarted in January 2022. Additionally, DMC also no longer requires VA Form 5655 to approve repayment plans extending 60 months or fewer. Previously, VA Form 5655 was required to approve repayment plans extending greater than 12 months. Repayment plans on compensation and pension benefit overpayments now also automatically extend for 36 months instead of 12 months when over the minimum monthly payment threshold. Due to these reasons, form usage has fluctuated.

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Annual Cost to Federal Government: $1,105,269

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 09/29/2023

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