Information Collection

Testing of Model Bankruptcy Periodic Forms for Mortgage Servicing

IC 215621 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⚠️ Notice: This information collection may be referencing outdated material.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
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

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:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.