Information Collection

CFPB IRS Tax Check Waiver Form

IC 204713 under ICR 201211-3170-001 · OMB 3170-0037.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3170-0037 can be found here:

Documents and Forms

Document Name Document Type
Form 3170-XXXX CFPB IRS Tax Check Waiver Form Form
3170-XXXX CFPB IRA Tax Check Waiver Form CFPB IRS Tax Check Waiver Form.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	CFPB IRS Tax Check Waiver Form	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	3170-XXXX	CFPB IRA Tax Check Waiver Form	CFPB IRS Tax Check Waiver Form.pdf		Yes	Yes	Fillable Printable

Line of Business: General Government

Subfunction: Executive Functions

Privacy Act System of Records
Title: CFPB Advisory Boards and Committees	FR Citation: 77 FR 12034

Number of Respondents: 100	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 80 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	100	100
Annual IC Time Burden (Hours)	17	17
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.