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⚠️ Notice: This information collection may be referencing outdated material.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

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

Information Collection (IC) Details

View Information Collection (IC)

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:

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 %

	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

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.