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VA Financial Hardship Letter – Sample

A Veterans Affairs (VA) financial hardship letter is used by a veteran to request debt relief, co-pay exemption, or an appeal on a previous VA decision due to extreme financial hardship. Proving financial hardship to the VA can also help the veteran skip the VA's backlog of claims and receive their benefits more quickly.

Updated October 24, 2024

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Sample

Chris Evans
123 America Rd.
Kansas City, MO 64030Oct. 31, 2022Veterans Affairs
333 Office St.
Los Angeles, CA 90021To Whom It May Concern:My name is Chris Evans, and I’m writing to request debt relief for my co-pay balance of $9,000 due to unforeseen financial duress caused by a serious sporting accident on Aug. 15.

The accident severely shattered both my kneecaps and broke my legs. According to my doctors, I will not be able to move around without the help of a wheelchair for at least a year. Due to my inability to move or work, I was fired from my restaurant job on Sep. 1 with no severance pay. Since then, with mounting medical bills and no income, I fell behind on my rent payments. Two days ago, I received an eviction notice giving me seven days to pay my due rent or move out. I have no family to assist me during this time of duress.

I’ve attached a copy of my eviction notice, medical documents, a letter from my former employer, and my bank statements. I sincerely ask you to consider granting full relief of my co-debt so that I can get back on my feet, both physically and financially. Thank you so much for your consideration and time.

Sincerely,

Chris Evans

 

How to Request Debt Relief

  1. Download and fill out a financial status report (VA Form 5655).
  2. Write a financial hardship letter detailing your situation.
  3. Submit the completed form and letter along with supplementary documents by mail or in person at a local VA medical center.

How to Request a Co-Pay Exemption/Hardship Determination

  1. Download and fill out a request for hardship determination (VA Form 10-10SH).
  2. Write a financial hardship letter detailing your situation.
  3. Submit the completed form and letter along with supplementary documents by mail or in person at a local VA medical center.