Financial Status Report

OMB 2900-0165

Information reported on this form is necessary to evaluate eligibility for waiver of collection, payment plans or compromises and to determine hardship imposed by an offset schedule as required under 32 USC 3711, 3716 and 5 USC 5514.

The latest form for Financial Status Report expires 2023-10-31 and can be found here.

Latest Forms, Documents, and Supporting Material

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

All Historical Document Collections

202306-2900-026 Approved with change	Revision of a currently approved collection	2023-09-29
201911-2900-007 Approved without change	Reinstatement with change of a previously approved collection	2020-06-02
201501-2900-004 Approved without change	Revision of a currently approved collection	2015-05-27
201203-2900-020 Approved without change	Extension without change of a currently approved collection	2012-07-06
200810-2900-010 Approved with change	Extension without change of a currently approved collection	2009-06-05
200605-2900-010 Approved without change	Extension without change of a currently approved collection	2006-05-16
200305-2900-003 Approved without change	Extension without change of a currently approved collection	2003-05-20
200005-2900-001 Approved without change	Reinstatement with change of a previously approved collection	2000-05-19
199109-2900-002 Approved without change	Extension without change of a currently approved collection	1991-09-17
198809-2900-007 Approved without change	Extension without change of a currently approved collection	1988-09-30
198707-2900-014 Approved without change	Extension without change of a currently approved collection	1987-07-31
198408-2900-017 Approved without change	Reinstatement with change of a previously approved collection	1984-08-09
198107-2900-037 Approved with change	No material or nonsubstantive change to a currently approved collection	1981-07-17
198010-2900-001 Approved with change	No material or nonsubstantive change to a currently approved collection	1980-10-22
198009-2900-010 Approved without change	Extension without change of a currently approved collection	1980-09-29
197512-2900-018 Approved without change	Revision of a currently approved collection	1975-12-03