GenIC Submission Template - Tax Time 2015

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:
Tax Time Post-Season Survey 2015
2. PURPOSE:
Determine the effectiveness of CFPB training and materials in helping VITA volunteers encourage savings among
clients of VITA sites.

3. DESCRIPTION OF RESPONDENTS:
Staff and administrators at VITA sites who attended CFPB training Webinars and requested CFPB printed materials.

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
[ ] In-person
[ ] Small Discussion Group
[ ] Other, Explain ______________________

[ ] Telephone
[ ] Mail
[ ] Focus Group

b. Will interviewers or facilitators be used?
[ ] Yes [x] No [ ] 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
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
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how you will select them?

We will use the list of Webinar attendees (collected by vendor, Information Experts) combined and de-duped from
the list of e-mail addresses for people who e-mailed us to request printed materials (to be provided by CFPB to
Information Experts).

6. PERSONALLY IDENTIFIABLE INFORMATION:
a. Is personally identifiable information (PII) collected? [x] Yes [ ] No
b. If Yes, is the information that will be collected included in records that are subject
to the Privacy Act of 1974? [ ] Yes [x] No [ ] Not Applicable
If applicable, what is the link to the Privacy Impact Assessment (PIA)?
Consumer Education PIA
http://files.consumerfinance.gov/f/201409_cfpb_consumer-education_pia.pdf
c. If Applicable, has a System or Records Notice (SORN) been published?
[ ] Yes [ ] No [x] Not Applicable
If Yes, provide Federal Register citation for the SORN __ FR ______.

7. INCENTIVES:
a. Is an incentive provided to participants? [ ] Yes [x] No
b. If Yes, provide the amount or value of the incentive? $___________.
c. If Yes, provide a statement justifying the use and amount of the incentive.

8. BURDEN ESTIMATES:
Information Collection

Number of
Respondents

VITA site survey
Totals

Frequency

75
1
75 //////////////////////

Number of
Annual
Responses

Response
Time
(hours)

Burden
Hours

75
0.08
75 ////////////////////////////

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

$5,000

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10. CERTIFICATIONS:
CERTIFICATION PURSUANT TO 5 CFR 1320.9, AND THE RELATED PROVISIONS
OF 5 CFR 1320.8(b)(3) :
By submitting this document, the Bureau certifies the following to be true:
(a) It is necessary for the proper performance of agency functions;
(b) It avoids unnecessary duplication;
(c) It uses plain, coherent, and unambiguous terminology that is understandable to
respondents;
(d) Its implementation will be consistent and compatible with current reporting and
recordkeeping practices;
(e) It indicates the retention period for recordkeeping requirements;
(f) It informs respondents of the information called for under 5 CFR 1320.8(b)(3):
(i) Why the information is being collected;
(ii) Use of information;
(iii) Burden estimate;
(iv) Nature of response (voluntary);
(v) Nature and extent of confidentiality; and
(vi) Need to display currently valid OMB control number;
(g) It was developed by an office that has planned and allocated resources for the efficient
and effective management and use of the information to be collected;
(h) It uses effective and efficient statistical survey methodology; and
(i) It makes appropriate use of information technology.

CERTIFICATION FOR INFORMATION COLLECTIONS SUBMITTED UNDER A
GENERIC INFORMATION COLLECTION PLAN
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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 data collection is not statistically significant, the sample is not intended to be
representative, and the results will not be used to make inferences beyond the survey
sample.
The results will not be used to measure regulatory compliance or for program
evaluation.

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