Information Collection

Financial Status Report

IC 260945 under ICR 202607-2900-008 · OMB 2900-0165.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 5655 Financial Status Report Financial Status Report	Form
5655 Financial Status Report VA Form 5655 (Proposed Mock-Up SEP 2026).pdf	Form
2026-15355 60 Day 2900-0165.pdf 2900-0165 60 Day Publication	IC Document

IC Title:

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 1.982 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:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	5655			https://www.va.gov/manage-va-debt/ and/or https://www.va.gov/contact-us/ask-va/introduction	Yes	Yes	Fillable Fileable

Line of Business: General Government

Subfunction: Legislative Functions

Privacy Act System of Records

Title: Benefits Accounts Receivable Records (BARR)-VA

FR Citation: 91 FR 40670

Number of Respondents: 150,871

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 40 %

table that charts list of burden
	Requested	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	150,871	117,536	33,335
Annual IC Time Burden (Hours)	150,871	117,536	33,335
Annual IC Cost Burden (Dollars)	5,060,213	4,068,163	992,050

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
2900-0165 60 Day Publication		09/25/2026

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

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