Financial Status Report

Documents and Forms

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

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 38 CFR 1.982 38 CFR 1.983 38 CFR 1.941 38 CFR 1.942 38 CFR 1.931 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: 33,335	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 40 %

	Approved	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	33,335	-82,816	116,151
Annual IC Time Burden (Hours)	33,335	-82,816	116,151
Annual IC Cost Burden (Dollars)	992,050	992,050	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.