IC Submission Template

Request for Approval under the “Generic Clearance for the Collection of
Qualitative Feedback on the Service Delivery of the Consumer Financial
Protection Bureau” (OMB Control Number: 3170-0024)
1. TITLE OF INFORMATION COLLECTION:
Community Bank Advisory Council, Credit Union Advisory Council and Academic
Research Council Post-Meeting Surveys
2. PURPOSE:
The surveys are used to collect annual information regarding the content and execution of
meetings throughout a meeting year.

3. DESCRIPTION OF RESPONDENTS:
The respondents are members of the respective Councils that have participated in
meetings. The respondents include representatives from community banks, credit unions
and academic researchers.
4. TYPE OF COLLECTION (ADMINISTRATION OF THE INSTRUMENT):
a.

How will you collect the information? (Check all that apply)
[ x ] Web-based or other forms of Social Media
[ x ] In-person
[ ] Small Discussion Group
[ ] Other, Explain ______________________

[ x ] Telephone
[ ] Mail
[ x ] Focus Group

b. Will interviewers or facilitators be used?
[ ] Yes [ ] No [ X ] Not Applicable

5. FOCUS GROUP OR SURVEY:
If you plan to conduct a focus group or survey, please provide answers to the following
questions:
a. Do you have a customer list or something similar that defines the universe of potential
respondents and do you have a sampling plan for selecting from this universe?
[ x ] Yes [ ] No [ ] Not Applicable

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b. If the answer is yes, please provide a description below. If the answer is no, please
provide a description of how you plan to identify your potential group of respondents and
how you will select them?
The respondents are members of the respective Councils with terms set by the Council
bylaws.
6. PERSONALLY IDENTIFIABLE INFORMATION:
a. Is personally identifiable information (PII) collected? [ ] Yes [ X ] No
b. If Yes, is the information that will be collected included in records that are subject
to the Privacy Act of 1974? [ ] Yes [ ] No [ X ] Not Applicable
c. If Applicable, has a System or Records Notice been published?
[ ] Yes [ ] No [ X ] Not Applicable

7. INCENTIVES:
a. Is an incentive provided to participants? [ ] Yes [ X ] No
b. If Yes, provide the amount or value of the incentive? $___N/A_____.
c. If Yes, provide a statement justifying the use and amount of the incentive.
N/A

8. BURDEN ESTIMATES:
Information Collection

Community Bank Advisory Council Post-Meeting
Survey
Credit Union Advisory Council Post-Meeting
Survey
Academic Research Council Post-Meeting Survey
Totals

Number of
Respondents

Participation
Time
(hours)

Burden
Hours

16

.17

3

16

.17

3

16
.17
48 ////////////////////////

3
9

9. FEDERAL COST: The estimated annual cost to the Federal government is $___0___.

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10. CERTIFICATION:
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By submitting this document, the Bureau certifies the following to be true:
The collection is voluntary.
The collection is low-burden for respondents and low-cost for the Federal Government.
The collection is non-controversial and does not raise issues of concern to other federal
agencies.
The results are not intended to be disseminated to the public.
Information gathered will not be used for the purpose of substantially informing influential
policy decisions.
The collection is targeted to the solicitation of opinions from respondents who have
experience with the program or may have experience with the program in the future.
The results will not be used to measure regulatory compliance or for program
evaluation.

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