Testing of Model Bankruptcy Periodic Forms for Mortgage Servicing

Generic Clearance for Development and/or Testing of Model Forms, Disclosures, Tools, and Other Similar Related Materials

⚠️ Notice: This information collection may be referencing outdated material.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
Bankruptcy Consumer Testing Discussion Guide.docx Other-Discussion Guide
Recruiting Language.docx Other-Recruitment Screener
Screener.docx Other-Participation screener
PRA Statement for linking.doc Other-PPRA Statement for Screener
20150227_RMR_User Testing_CFPB022_Final.docx Other-Privacy Act Statement
Back of Periodic Mortgage Stmt.pdf Other-Exhibit
Appendix H-30(F) (proposed).docx Other-Exhibit
Appendix H-30(F) (alternative).docx Other-Exhibit
Appendix H-30(E) (proposed).docx Other-exhibit
Appendix H-30(E) (alternative).docx Other-exhibit
IC Template.docx IC Submission Template IC Document

Information Collection (IC) Details

IC Title:	Testing of Model Bankruptcy Periodic Forms for Mortgage Servicing	Agency IC Tracking Number:	Ti 10372

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-Discussion Guide	Bankruptcy Consumer Testing Discussion Guide.docx	No		Paper Only
Other-Recruitment Screener	Recruiting Language.docx	Yes	Yes	Fillable Fileable
Other-Participation screener	Screener.docx	Yes	Yes	Fillable Fileable
Other-PPRA Statement for Screener	PRA Statement for linking.doc	Yes	No	Printable Only
Other-Privacy Act Statement	20150227_RMR_User Testing_CFPB022_Final.docx	Yes	No	Printable Only
Other-Exhibit	Back of Periodic Mortgage Stmt.pdf	No		Paper Only
Other-Exhibit	Appendix H-30(F) (proposed).docx	No		Paper Only
Other-Exhibit	Appendix H-30(F) (alternative).docx	No		Paper Only
Other-exhibit	Appendix H-30(E) (proposed).docx	No		Paper Only
Other-exhibit	Appendix H-30(E) (alternative).docx	No		Paper Only

Line of Business: Economic Development

Subfunction: Financial Sector Oversight

Privacy Act System of Records
Title: : CFPB.022-Market and Consumer Research Records	FR Citation: 77 FR 67802

Number of Respondents: 300	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	351	351
Annual IC Time Burden (Hours)	76	76
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
IC Submission Template	IC Template.docx	03/09/2015

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