Information Collection

Application for Non-Profit Budget and Credit Counseling Agencies

IC 11781 under ICR 201208-1105-001 · OMB 1105-0084.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1105-0084 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form xxxx Application for Non-Profit Budget and Credit Counseling Agencies	Form
1105-0084_04-Credit Counseling Instructions_080112.doc	Instruction
xxxx CC Application Appendix A 1105-0084_06-CC_Application_Appendix_A_080112.pdf	Form
xxxx CC Application B 1105-0084_07-CC_Application_Appendix_B_080112.pdf	Form
xxxx CC Appllication C 1105-0084_08-CC_Application_Appendix_C_080112.pdf	Form
xxxx CC Application Appendix d 1105-0084_09-CC_Application_Appendix_D_080112.pdf	Form
xxxx CC Application Appendix E 1105-0084_10-CC_Application_Appendix_E_080112.pdf	Form
OMB Number 1105-00 Credit Counseling Application 1105-0084_05-Credit Counseling Application_082112.doc	Form

IC Title:

Application for Non-Profit Budget and Credit Counseling Agencies

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	xxxx	CC Application Appendix A	1105-0084_06-CC_Application_Appendix_A_080112.pdf	Yes	Yes	Fillable Printable
Form	xxxx	CC Application B	1105-0084_07-CC_Application_Appendix_B_080112.pdf	Yes	Yes	Fillable Printable
Form	xxxx	CC Appllication C	1105-0084_08-CC_Application_Appendix_C_080112.pdf	Yes	Yes	Fillable Printable
Form	xxxx	CC Application Appendix d	1105-0084_09-CC_Application_Appendix_D_080112.pdf	Yes	Yes	Fillable Printable
Form	xxxx	CC Application Appendix E	1105-0084_10-CC_Application_Appendix_E_080112.pdf	Yes	Yes	Fillable Printable
Instruction			1105-0084_04-Credit Counseling Instructions_080112.doc	Yes	No	Fillable Fileable
Form	OMB Number 1105-0084	Credit Counseling Application	1105-0084_05-Credit Counseling Application_082112.doc	Yes	Yes	Fillable Fileable

Line of Business: General Government

Subfunction: Executive Functions

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 175

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	175	-125	300
Annual IC Time Burden (Hours)	808	-2,192	3,000
Annual IC Cost Burden (Dollars)	8,750	-141,250	150,000

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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