Instructions to Obtain a Financial Status Report — VA Form 5655
In order to obtain a Financial Status Report VA Form 5655 over the Internet, do the following:
- Go to the VA.gov website.
- On the bottom of the page, under "Quick List" section, click on "VA Forms".
- Enter 5655 in the Form Number block.
You will be given two options:
5655blank — Financial Status Report (blank copy)
This form may be printed and filled out manually.
5655 — Financial Status Report
This form may be filled out online and emailed to firstname.lastname@example.org (see instructions below).
Instructions to Request a Lower Withholding from Current VA Benefits
To request a lower Withholding: Complete and sign the Financial Status Report - VA Form 5655. Specify "Lower Withholding" in Block "3" of Financial Status Report and enter amount of the monthly withholding amount you are requesting in block "24B".
If you are requesting a Partial Refund of a benefit that was already taken and applied to the debt, please state "Lower Withholding/Refund" in Block "3" of the Financial Status Report.
Instructions to Request a Waiver
To request a Waiver: Complete and sign the Financial Status Report - VA Form 5655. Specify "Waiver" in Block "3" of Financial Status Report. In addition to completing the Financial Status Report, please write a letter on a separate sheet of paper stating that you are "Requesting a Waiver".
NOTE: The word "waiver" must be included in your letter. Explain why you are requesting the waiver and why you don’t feel you should be held responsible for this debt. You may include supporting documentation you feel will help your case.
- Remember to put your file number and name on the top of each page of documentation.
- Please Note: You have 180 days from the date of the first notification letter to request a waiver.
Instructions to Establish a Monthly Payment Arrangement Where Payments Would Be Submitted to VA to Credit the Debt
To request a lower Payment Plan: Complete and sign the Financial Status Report -VA Form 5655. Specify "Payment Plan" in Block "3" of Financial Status Report and enter the monthly payment amount you are requesting in block "24B".
You will receive notification from Debt Management Center either agreeing to the requested amount or advising you of the amount we would be able to accept.
Instructions to Submit the Financial Status Report — VA Form 5655, or Any Additional Information to Debt Management Center
You can submit the Financial Status Report and any additional documents the following ways:
- Via Fax: 612-970-5798
- Via Mail:
VA Debt Management
P. O. Box 11930
St. Paul, MN 55111-0930
Via Email: email@example.com
Note: This and email box in the correspondence unit. They will process your request in the order it is received. If you send via Email, please indicate the purpose of the Email on the "Subject" line i.e.: REPAY, WAIVER, PAYMENT PLAN or REPAY and WAIVER.
Make sure to keep a copy of all documents you send to the Debt Management Center.