OMB control number

Financial Status Report

OMB 2900-0165 · VA.

OMB 2900-0165

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.

The latest form for Financial Status Report expires 2026-11-30 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All Historical Document Collections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

OMB Details

Financial Status Report

Federal Enterprise Architecture: General Government - Legislative Functions

Form 5655

Financial Status Report

www1.va.gov/debtman

Form

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.