Information Collection

Customer Complaint Form

IC 20142 under ICR 201103-1557-005 · OMB 1557-0232.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1557-0232 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Customer Complaint Form	Form and Instruction
Customer Complaint Form Customer Complaint Form.doc	Form and Instruction

IC Title:

Customer Complaint Form

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	N/A	Customer Complaint Form	Customer Complaint Form.doc		Yes	Yes	Fillable Fileable Signable

Line of Business: Economic Development

Subfunction: Financial Sector Oversight

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 81,180

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to New Statute	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	81,180	1,180	58,000	22,000
Annual IC Time Burden (Hours)	6,738	98	4,807	1,833
Annual IC Cost Burden (Dollars)	0	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.