Web Post

Consumer Financial Protection Bureau: Compliance Cost Information Collection
The Consumer Financial Protection Bureau (“the CFPB”) is interested in learning about how its
potential proposed regulations may affect the compliance costs and daily operations of consumer
financial services providers.
To gather information from providers of consumer financial products and services, the CFPB is
looking for institutions who would like to provide input on how proposed regulations may
impact their regulatory compliance costs and businesses. This webpage will allow the Bureau to
compile a list of institutions who are interested in participating in this information collection.
The CFPB intends to use various methods to collect compliance cost information. Some
respondents may be asked to participate in a focus group, structured interview, or conference
call, while others may be asked to complete a written questionnaire or online survey.
If you or your institution is interested in participating, please provide us with your contact
information, and information on the institution you represent. The CFPB will not disclose the
personally identifiable information collected except to the extent that it is required to do so by
law and as provided in the Privacy Act Statement listed below. Additionally, the Bureau will
treat the information received from you consistent with our confidentiality regulations at 12
C.F.R. Part 1070, et seq.
An agency may not conduct or sponsor, and a person is not required to respond to, a collection of
information unless the collection of information displays a valid control number assigned by the Office of
Management and Budget (OMB). The OMB control number for this collection is 3170-XXXX. The
collection expires on XX/XX/XXXX.

ABOUT YOU:
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Name
Title
E-Mail
Phone

ABOUT YOUR INSTITUTION:
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Name
State
Type (you may choose more than one)
o Commercial Bank
o Savings Bank/Savings Institution
o Credit Union
o Mortgage Lender
o Mortgage Brokerage
o Mortgage Servicer
o Other Brokerage
o Payday Lender

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o
o
o
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o
o
o
o
o
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Private Education Lender
Student Loan Servicer
Automobile Finance Company
Other Consumer Finance Company
Credit Reporting Agency
Debt Collector
Money Transmitter
Check Casher
Other Money Services Business
Debt Relief/Settlement Company
Prepaid Value Issuer or Program Manager
Nonbank Credit Card Issuer
Payment Processor
Compliance Consultant
Payment Network
Other (please specify)

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Regulatory ID
o RSSD-ID
o FDIC Certification Number
o OCC Charter Number
o NCUA Charter Number
o NMLS Unique Identifier Number
o State License/Charter Number
o N/A

-

Total Revenue (indicate amount for most recent calendar or fiscal year)

Notice of Collection Under the Privacy Act of 1974, 5 U.S.C. § 552a -- As Amended
(Privacy Act Notice): The information in the system is being collected to understand the effects
of potential regulations on providers and consumers, as well as the ways in which providers may
comply with potential regulations, and the costs associated with compliance.
Identifying information is collected to identify the individual providing the information.
Identifying information collected may be used by and disclosed as permitted by the Privacy Act,
5 U.S.C. § 552a, to employees, contractors, agents, and others authorized by the Consumer
Financial Protection Bureau to receive this information to assist in related activities. It may also
be disclosed:
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to a court, magistrate, or administrative tribunal in the course of a proceeding;
for enforcement, statutory, and regulatory purposes;
to another federal or state agency or regulatory authority;
to a member of Congress; to the Department of Justice, a court, an adjudicative body or
administrative tribunal, or a party in litigation;
to the public, members of the media, federal, state, and local government officials, or
other recipients of public relations materials issued by the CFPB about the activities of
the CFPB; and

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pursuant to the CFPB’s published Privacy Act system of records notice, CFPB.013 –
External Contact Database.

You are not required to submit or provide any identifying information; however, not doing so
may impact the purpose of the survey or focus group and may provide inaccurate results.
The collection of this information is authorized by Public Law 111-203, Title X, Sections 1011,
1012, 1021, codified at 12 U.S.C. 5491, 5492, 5511.

[SUBMIT]

Thank you for volunteering. You will be sent a follow-up e-mail confirming your participation
in the information collection.