Create va form in minutes using a fillable PDF editor. Fill va form va instantly, download blank or editable online. Sign , fax and printable from PC, iPad, tablet or mobile. No software. Try Now!. VA Form , Financial Status Report, is used to determine eligibility for waiver of collection, for the acceptance of a compromise offer or for a payment plan.

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Your balance ga considered delinquent if it remains unpaid after the balance due date on your initial billing statement, which is typically thirty 30 days after the statement date. When does your debt become delinquent? If no additional debt exists with the VA, the payment will be applied as a credit balance and refunded 5655 60 days, unless a refund is requested sooner.

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Debt – Office of Veterans Affairs – Valencia College

Will you be able to continue receiving health care services if your bill is referred to Treasury? The claimant will need to provide information about their finances along with the finances of their spouse. However, if the information is not furnished, your eligibility for fodm, compromise.

If Federal agencies are not successful at collecting a debt, they are required under the Digital Accountability and Transparency Act DATA of to refer eligible delinquent non-tax debt to TOP for debt collection action within days. In the event the debt is recovered through TOP, a fee is charged per transaction. Bureau, State Veterans Cemetery. A compromise means you propose a lesser amount as full settlement of the debt. To request a hardship determination, send a letter explaining any financial hardship these charges will cause you and a completed Request for Hardship Determination VA Form HS.

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Section V is for your assets, including your cash in the bank and on hand, your vehicles, savings bonds, and any real estate you own.

Indicate your proposed monthly payment amount in paragraph 1A.

For Box 24A, subtract your total monthly expenses from your total monthly net income. Url of this page: In 24B, you should mark the amount you can reasonably pay toward your flrm debt on a monthly basis. This form should be used by people who are in debt to the VA. The information you furnish on this form is almost always used to determine if you are eligible for waiver of a debt, for the. You will incur collection fees from Treasury based upon a percentage of your outstanding bill s and length of time outstanding.

Why is the VA referring your delinquent debt vx the Department of the Treasury? The VA will either want a lump sum of the payment or payments made over time, possibly including interest rates. This record is kept by the VA to determine how to proceed with the repayment. The form captures a zoomed-out look at their overall finances. The routine uses for which VA may disclose. You have the right to establish a monthly repayment plan at any time during your enrollment in VA health care if you cannot pay your debt in full.


VA Form 5655 Financial Status Report

Your explanation should include why you are not responsible for the debt and any undue hardship the payment of the debt would cause you. Section I is related to your personal data. If more space is needed for any vq, continue.

To do so, submit a written request for hearing with your waiver request. Each dependent receives an additional stipulation in order for the parents to best care for them. If your gross household income has 56655 from the previous income year, you may be eligible for a Hardship Determination which provides future exemption from medical and hospital care copays for a determined period of time.

To pay a bill that has been referred to Treasury, contact Debt Management Services toll free at between 8: There are a number of reasons a person might fill out a Financial Status Report. Vorm is the report the VA will use to at-a-glance approve your application for a repayment adjustment.

However, if the VA has any questions, they may ask for these documents later. What happens once your bill becomes delinquent? This piece of paperwork reflects your financial status. Bureau, State Veterans Home – Lewiston. VA may not conduct or sponsor, and respondent is not required to respond to this collection of information 5655 it displays a valid OMB.