Information Collection

Pre-Paid Disclosure Forms User Testing (Interviews)

IC 209918 under ICR 201206-3170-002 · OMB 3170-0022.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3170-0022 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Prepaid User Testing Recruitment Screener (12-20-13) v2 clean.pdf	Other-Screener for Candidates
Prepaid Cards Interview Protocol (12-26-13) 1216 v3 clean.pdf	Other-Interviewer's questionaire
Prepaid User Testing Interview OMB Submission Form (12-20-13) 1226v4 clean.pdf Generic submission Form	IC Document
Prepaid User Testing Consent Form (12-20-13) clean.pdf Informed Consent Form	IC Document
Prepaid Form A Full Dynamic (12-20-13).pdf Model Form A	IC Document
Prepaid Form C Summary Static_Mult Fee Plan_QR (12-20-13).pdf Model Form C	IC Document
Prepaid Form D Hybrid (12-20-13) (2).pdf Model Form D	IC Document
Prepaid Form E Online (12-23-13) 1226.pdf Model Form E	IC Document

IC Title:

Pre-Paid Disclosure Forms User Testing (Interviews)

Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation: 12 CFR 1005

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
Other-Screener for Candidates			Prepaid User Testing Recruitment Screener (12-20-13) v2 clean.pdf		No		Paper Only
Other-Interviewer's questionaire			Prepaid Cards Interview Protocol (12-26-13) 1216 v3 clean.pdf		No		Paper Only

Line of Business: Economic Development

Subfunction: Financial Sector Oversight

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 150

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 Agency Discretion
Annual Number of Responses for this IC	150	150
Annual IC Time Burden (Hours)	58	58
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Generic submission Form	Prepaid User Testing Interview OMB Submission Form (12-20-13) 1226v4 clean.pdf	01/03/2014
Informed Consent Form	Prepaid User Testing Consent Form (12-20-13) clean.pdf	01/03/2014
Model Form A	Prepaid Form A Full Dynamic (12-20-13).pdf	01/03/2014
Model Form C	Prepaid Form C Summary Static_Mult Fee Plan_QR (12-20-13).pdf	01/03/2014
Model Form D	Prepaid Form D Hybrid (12-20-13) (2).pdf	01/03/2014
Model Form E	Prepaid Form E Online (12-23-13) 1226.pdf	01/03/2014

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