Small Dollar Lending Rule Disclosure Testing (Payday)

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⚠️ Notice: This information collection may be referencing outdated material.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
Small Loans Discussion Guide 7-1-15 (FINAL).pdf Other-Discussion Guide
Draft Origination Forms 7-8-15.pdf Other-Test Disclosure - Orgination
Draft Payment Forms 7-16-15.pdf Other-Test Disclosure - Payment
Small Loans Informed Consent.7-30-15(OMB Revision).pdf Other-Informed Consent
Small Loans Recruiting Language.7-30-15(OMB Revision).pdf Other-Recruiting Language
Small Loans Screener.7-30-15 (OMB Revision).pdf Other-Screener
20150701 RMR Small Dollar Lending Rule Disclosure Phone Confirmation Privacy Act Statement.pdf Privacy Act Statement - Phone Confermation IC Document
20150701 RMR Small Dollar Lending Rule Disclosure Web Screener Privacy Act Statement.pdf Privacy Act Statement - Web Screener IC Document
20150701 RMR Small Dollar Lending Rule Disclosure Moderators Guide Privacy Act Statement.pdf Privacy Act Statement - Interviews IC Document
IC Template 3170-0022 Small Loans PAYDAY 7-30-15 (OMB Revision).docx IC Template - small loans (payday) IC Document

Information Collection (IC) Details

IC Title:	Small Dollar Lending Rule Disclosure Testing (Payday)	Agency IC Tracking Number:

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	Small Loans Discussion Guide 7-1-15 (FINAL).pdf	No		Paper Only
Other-Test Disclosure - Orgination	Draft Origination Forms 7-8-15.pdf	No		Paper Only
Other-Test Disclosure - Payment	Draft Payment Forms 7-16-15.pdf	No		Paper Only
Other-Informed Consent	Small Loans Informed Consent.7-30-15(OMB Revision).pdf	No		Paper Only
Other-Recruiting Language	Small Loans Recruiting Language.7-30-15(OMB Revision).pdf	Yes	Yes	Fillable Fileable
Other-Screener	Small Loans Screener.7-30-15 (OMB Revision).pdf	Yes	Yes	Fillable Fileable

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: 168	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 50 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	252	252
Annual IC Time Burden (Hours)	73	73
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Privacy Act Statement - Phone Confermation	20150701 RMR Small Dollar Lending Rule Disclosure Phone Confirmation Privacy Act Statement.pdf	07/20/2015
Privacy Act Statement - Web Screener	20150701 RMR Small Dollar Lending Rule Disclosure Web Screener Privacy Act Statement.pdf	07/20/2015
Privacy Act Statement - Interviews	20150701 RMR Small Dollar Lending Rule Disclosure Moderators Guide Privacy Act Statement.pdf	07/22/2015
IC Template - small loans (payday)	IC Template 3170-0022 Small Loans PAYDAY 7-30-15 (OMB Revision).docx	07/31/2015

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