Fill VA Form 5655 online
Financial Status Report
or choose your own copy:
- ✓ Official current version
- ✓ Free download, no account
- ✓ No card, no trial
- ✓ Never uploaded
VA Form 5655 in short
VA Form 5655 is a Financial Status Report that tells VA about your income, expenses, assets and debts when you owe VA money. VA uses it to decide requests for a waiver, a compromise offer, or a repayment plan longer than 5 years. You can submit it online or by mail.
| Issued by | U.S. Department of Veterans Affairs (VA) |
|---|---|
| Current version | Rev. January 2024 (checked 2026-10-25) |
| Who fills it in | A person who owes a VA debt and wants a waiver, a compromise, or a repayment plan of more than 5 years. If you are married, VA also needs your spouse's financial details, and the form asks for the spouse's signature. |
| Who receives it | For debts from disability compensation, pension or education benefits: the VA Debt Management Center. For VA health care copay debts: the business or health administration office at your nearest VA medical center. |
| Where to send it | Benefit debts: online on VA.gov, or by mail to U.S. Department of Veterans Affairs, Debt Management Center, PO Box 11930, St. Paul, MN 55111. Health care copay debts: mail or bring the form and statement to your nearest VA medical center's business or health administration office. |
| Deadline | The form has no deadline of its own. If a VA debt letter gives a date to respond, follow that letter. VA says you need to send a new report if your financial situation changes. |
| Official links | Official page · Official PDF · Official instructions |
How to fill out VA Form 5655, line by line
| Items 1 to 3 | SSN, file number and reason Your Social Security number, VA file number, and why you are filling in the form: waiver, compromise, payment plan or other. |
| Section I, items 4 to 12 | Personal data and employment Name, address, phone, date of birth, marital status, spouse's name and ages of other dependents. Then your and your spouse's jobs for the past 2 years with employer names and dates. |
| Section II, items 13 to 17 | Monthly income Gross salary, payroll deductions, net take-home pay, and other income such as VA benefits or Social Security, for you and your spouse. If income varies, VA says to give an average. |
| Section III, items 18 to 23 | Monthly expenses Rent or mortgage, food, utilities, other living expenses, and monthly payments on debts from Section VI. |
| Section IV, items 24A and 24B | Discretionary income Net income minus expenses, and the amount you can pay each month toward the VA debt. |
| Section V, items 25 to 33 | Assets Cash in bank and on hand, cars, trailers or boats, savings bonds, stocks, real estate and other assets. VA says estimated resale values are accepted. |
| Section VI, item 34 | Installment contracts and other debts Each debt you pay in regular installments, with creditor, purpose, original amount, unpaid balance, monthly payment and any past-due amount. Do not include living expenses. |
| Section VII, items 35 and 36 | Bankruptcy and additional data Whether you have been adjudicated bankrupt, with discharge date, court and docket number. Item 36 is space for any extra explanation. |
| Section VIII, items 37 and 38 | Signatures You sign and date in 37A and 37B. Your spouse signs and dates in 38A and 38B. The form marks both signatures as required. |
Common mistakes to avoid
- Leaving out a personal statement. VA says waiver and compromise requests need one; by mail it goes in a separate letter.
- Missing the spouse's information or signature when married.
- Listing living expenses in Section VI. The form says to show only installment debts there.
- Not stating the reason in item 3 (waiver, compromise, payment plan or other).
- Sending a health care copay debt form to the Debt Management Center. VA says copay debts go to your nearest VA medical center.
- Using an old report after your finances changed. VA says to send a new one, for example after losing or starting a job.
- Leaving a monthly payment amount out of item 24B when asking for a payment plan.
Questions about VA Form 5655
When do I need VA Form 5655?
VA says you need it to request a repayment plan of more than 5 years, a compromise offer, or a waiver of a VA debt.
Where do I send VA Form 5655?
For compensation, pension or education debts, online or by mail to Debt Management Center, PO Box 11930, St. Paul, MN 55111. For health care copay debts, to your nearest VA medical center.
Do I need to send bills or receipts?
VA says you do not need to send copies of bills or receipts when you request help. VA may ask for more information later.
What if my income changes each month?
VA says to give your average monthly amount. You can divide last year's reported wages by 12.
What goes in the personal statement?
For a compromise, explain why you ask to pay less and the one-time amount you offer. For a waiver, explain why you feel you should not have to repay the debt.
Related forms
Tools for this form
Sources
Checked against the official sources on 2026-10-25. PDF Editor Hub is not affiliated with the U.S. Department of Veterans Affairs or any government agency. This page is general information, not legal or tax advice.