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⚠️ Notice: This information collection may be referencing outdated material.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

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

Information Collection (IC) Details

View Information Collection (IC)

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:

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 %

	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

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.