Information Collection

Application for Non-Profit Budget and Credit Counseling Agencies

IC 11781 under ICR 201202-1105-001 · OMB 1105-0084.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1105-0084 can be found here:

Documents and Forms

Document Name Document Type
Form xxxx Application for Non-Profit Budget and Credit Counseling Agencies Form
Credit Counseling Instructions_022212.doc Instruction
xxxx CC Application Appendix A CC_Application_Appendix_A.pdf Form
xxxx CC Application B CC_Application_Appendix_B.pdf Form
xxxx CC Appllication C CC_Application_Appendix_C.pdf Form
xxxx CC Application Appendix d CC_Application_Appendix_D.pdf Form
xxxx CC Application Appendix E CC_Application_Appendix_E.pdf Form
OMB Number 1105-00 Credit Counseling Application Credit Counseling Application_022212.doc Form
83I OMB.pdf OMB 83-I IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Application for Non-Profit Budget and Credit Counseling Agencies	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	xxxx	CC Application Appendix A	CC_Application_Appendix_A.pdf	Yes	No	Fillable Printable
Form	xxxx	CC Application B	CC_Application_Appendix_B.pdf	Yes	No	Fillable Printable
Form	xxxx	CC Appllication C	CC_Application_Appendix_C.pdf	Yes	No	Fillable Printable
Form	xxxx	CC Application Appendix d	CC_Application_Appendix_D.pdf	Yes	No	Fillable Printable
Form	xxxx	CC Application Appendix E	CC_Application_Appendix_E.pdf	Yes	No	Fillable Printable
Form	OMB Number 1105-0084	Credit Counseling Application	Credit Counseling Application_022212.doc	Yes	No	Fillable Fileable
Instruction			Credit Counseling Instructions_022212.doc	Yes	Yes	Printable Only

Line of Business: General Government

Subfunction: Executive Functions

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 300	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	300	300
Annual IC Time Burden (Hours)	3,000	3,000
Annual IC Cost Burden (Dollars)	150,000	150,000

Documents for IC

Title	Document	Date Uploaded
OMB 83-I	83I OMB.pdf	06/18/2009

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