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Request help with VA debt for overpayments and copay bills

Financial Status Report (VA Form 5655)

Is this the form I need?

This form is for Veterans or service members who need help with debt related to VA benefit overpayments or health care copays. Answer a few questions to find out if this is the form you need. If not, we’ll guide you to the best way to get help.

If you already know this is the form you need, you can go to the form now.

Need help?

If you have trouble using this online form, call our MyVA411 main information line at ().

If you need help with your request, you can appoint a VA accredited representative.
Get help filling out a form

If you have questions about your benefit overpayments, call us at (or from overseas). We’re here Monday through Friday, 7:30 a.m. to 7:00 p.m. ET.

If you have questions about your copay bills, call us at . We’re here Monday through Friday, 8:00 a.m. to 8:00 p.m. ET.