3170-XXXX Non-entity-specific Certification

Advisory Boards, Groups and Committees

Non-entity-specific certification

Certifications

OMB: 3170-0021

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OMB#3170-XXXX

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CERTIFICATION FOR NON-ENTITY-SPECIFIC PROJECTS

Academic Research Council



Project Name: (to be filled in by CFPB)


Brief Project Description: (to be filled in by CFPB)



Certification

I certify that I do not have any financial interests that could influence my work or advice on this project. If this changes, I will notify the CFPB before continuing to work on the project.


______________________________________________ ______________________

Signature Date


______________________________________________

Name (Print)




I am unable to certify to the above.



______________________________________________ ______________________

Signature Date


______________________________________________

Name (Print)



According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a valid OMB control number. The valid OMB control number for this collection is 3170-00XX. It expires on XX/XX/XXXX. The time required to complete this information collection is estimated to average approximately ten minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.

File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
File TitleCFPB Letterhead Sample Document Set Up
SubjectCFPB Letterhead Sample Document Set Up
AuthorConsumer Financial Protection Bureau
File Modified0000-00-00
File Created2021-01-30

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