Information Collection

Prepaid Interview Testing Phase 2

IC 216181 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⚠️ Notice: This information collection may be referencing outdated material.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
Attachment A - Prepaid Interview Testing Phase 2 Interview Protocol -final.pdf	Other-Interview Protocol
Attachment B1 - Prepaid Model Sample Forms Proposed Rule.pdf	Other-Model Disclosure
Attachment B2 - Prepaid Model Forms and Clauses for Phase 2.pdf	Other-Sample Disclosure
Attachment C - Prepaid InterviewTesting Phase 2 Recruitment Screener (4-16-15).pdf	Other-Recruitment Screener
Attachment D - Prepaid Consent Form.pdf	Other-Consent Form
RMR Prepaid Disclosure Testing (Phase 2) One on One Privacy Act Statement-final.pdf	Other-Privacy Act Statement-one on o
RMR Prepaid Disclosure Testing (Phase 2) Telephone Screener Privacy Act Statement-final.pdf	Other-Privacy act Statement for scre
OMB GenericSubmissionForm - Prepaid Interview Testing Phase 2 (4-16-15) (2).pdf IC Submission Template	IC Document

IC Title:

Prepaid Interview Testing Phase 2

Agency IC Tracking Number:

TI 10499

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Instrument File	Available Electronically?	Electronic Capability
Other-Interview Protocol	Attachment A - Prepaid Interview Testing Phase 2 Interview Protocol -final.pdf	No	Printable Only
Other-Model Disclosure	Attachment B1 - Prepaid Model Sample Forms Proposed Rule.pdf	No	Printable Only
Other-Sample Disclosure	Attachment B2 - Prepaid Model Forms and Clauses for Phase 2.pdf	No	Printable Only
Other-Recruitment Screener	Attachment C - Prepaid InterviewTesting Phase 2 Recruitment Screener (4-16-15).pdf	No	Printable Only
Other-Consent Form	Attachment D - Prepaid Consent Form.pdf	No	Printable Only
Other-Privacy Act Statement-one on one interviews	RMR Prepaid Disclosure Testing (Phase 2) One on One Privacy Act Statement-final.pdf	No	Printable Only
Other-Privacy act Statement for screener	RMR Prepaid Disclosure Testing (Phase 2) Telephone Screener Privacy Act Statement-final.pdf	No	Printable 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: 100

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	120	120
Annual IC Time Burden (Hours)	38	38
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
IC Submission Template	OMB GenericSubmissionForm - Prepaid Interview Testing Phase 2 (4-16-15) (2).pdf	04/16/2015

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