Information Collection

Debt Collection Disclosure Forms Focus Groups and User Experience Study (Round 2)

IC 214852 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⚠️ Notice: This information collection may be referencing outdated material.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
Debt Disclosure Privacy Statement_2014-5-14.docx (1).pdf Other-Privacy Statement
Debt Disclosure_Pre-Session Questionnaire_2014-5-14 (2).pdf Other-Questionnaire
Debt Disclosure_Screener (1).pdf Other-Screenr
FINAL Debt Disclosure_Consent Form_2014_5-14-14 (1).pdf Other-Consent form
G-Notice 1_2014-5-14.docx (1).pdf Other-sample notice
G-Notice 2_2014-5-14.docx (1).pdf Other-sample notice
Debt Disclosure User Experience Test Discussion Guide.pdf Other-Discussion Guide
IC Template_Debt Disclosure revised 2 5 15.docx Submission Template IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Debt Collection Disclosure Forms Focus Groups and User Experience Study (Round 2)	Agency IC Tracking Number:	10038 (Rev)

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Privacy Statement	Debt Disclosure Privacy Statement_2014-5-14.docx (1).pdf	No		Printable Only
Other-Questionnaire	Debt Disclosure_Pre-Session Questionnaire_2014-5-14 (2).pdf	No		Paper Only
Other-Screenr	Debt Disclosure_Screener (1).pdf	Yes	Yes	Fillable Fileable
Other-Consent form	FINAL Debt Disclosure_Consent Form_2014_5-14-14 (1).pdf	No		Paper Only
Other-sample notice	G-Notice 1_2014-5-14.docx (1).pdf	No		Paper Only
Other-sample notice	G-Notice 2_2014-5-14.docx (1).pdf	No		Paper Only
Other-Discussion Guide	Debt Disclosure User Experience Test Discussion Guide.pdf	No		Paper Only

Line of Business: Economic Development

Subfunction: Financial Sector Oversight

Privacy Act System of Records
Title: Consumer Education and Engagement Records	FR Citation: 77 FR 60382

Number of Respondents: 140	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	250	250
Annual IC Time Burden (Hours)	45	45
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Submission Template	IC Template_Debt Disclosure revised 2 5 15.docx	02/05/2015

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