Information Collection

Consumer Response Intake Form (Web)

IC 198357 under ICR 201307-3170-001 · OMB 3170-0011.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3170-0011 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Screenshot 1.png	Other-Screen shot
Screenshot 2.png	Other-Screen Shot
Screenshot 3.png	Other-Screen Shot
Screenshot 4 - Mortgage ONLY.png	Other-Screen Shot
Screenshot 4.png	Other-Screen Shot
10.6.11 intake screenshot 1.1.png	Other-Screen Shot
10.6.11 Mortgage intake screenshot 3.png	Other-Screen Shot
10.6.11 Mortgage intake screenshot 5.png	Other-Screen Shot
Steering Committee Mortgage intake screenshot 1.2.png	Other-Screen Shot
Steering Committee Mortgage intake screenshot 1.png	Other-Screen Shot
Steering Committee Mortgage intake screenshot 2.png	Other-Screen Shot
Steering Committee Mortgage intake screenshot 4.png	Other-Screen Shot
10.6.11 intake screenshot 1.1.png	Other-Screen Shot
Steering Committee Mortgage intake screenshot 1.png	Other-Screen Shot
Steering Committee Mortgage intake screenshot 1.2.png	Other-Screen Shot
Steering Committee Mortgage intake screenshot 2.png	Other-Screen Shot
Steering Committee Mortgage intake screenshot 4.png	Other-Screen Shot
10.6.11 Mortgage intake screenshot 3.png	Other-Screen Shot
10.6.11 Mortgage intake screenshot 5.png	Other-Screen Shot
2.17.12 - 1 - Bank accounts and services.png	Other-Screen Shot
2.17.12 - 1 - Student loan.png	Other-Screen Shot
2.17.12 - 1 - Vehicle and consumer loans.png	Other-Screen Shot
2.17.12 - 1.1 - Bank accounts and services.png	Other-Screen Shot
2.17.12 - 1.1 - Student loan - Federal.png	Other-Screen Shot
2.17.12 - 1.1 - Vehicle and consumer loans - vehicle loan, vehicle lease, installment loan.png	Other-Screen Shot
2.17.12 - 1.2 - Student loan - Not sure.png	Other-Screen Shot
2.17.12 - 1.2 - Vehicle and consumer loans - personal line of credit.png	Other-Screen Shot
2.17.12 - 1.3 - Student loan - Non-federal.png	Other-Screen Shot
2.17.12 - 2 - Bank accounts and services.png	Other-Screen Shot
2.17.12 - 2 - Student loan.png	Other-Screen Shot
2.17.12 - 2 - Vehicle and consumer loans.png	Other-Screen Shot
2.17.12 - 3 - Bank accounts and services.png	Other-Screen Shot
2.17.12 - 3 - Student loan.png	Other-Screen Shot
2.17.12 - 3 - Vehicle and consumer loans.png	Other-Screen Shot
2.17.12 - 4 - Bank accounts and services.png	Other-Screen Shot
2.17.12 - 4 - Student loan.png	Other-Screen Shot
2.17.12 - 4 - Vehicle and consumer loans.png	Other-Screen Shot
2.17.12 - 5 - Bank accounts and services.png	Other-Screen Shot
2.17.12 - 5 - Student loan.png	Other-Screen Shot
2.17.12 - 5 - Vehicle and consumer loans.png	Other-Screen Shot
2.17.12 - Universal confirmation page.png	Other-Screen Shot
Screenshots for Debt Collection Complaint (July 2013).pdf	Other-Screen Shots

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Consumer Response Intake Form (Web)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Screen shot	Screenshot 1.png	Yes	Yes	Fillable Fileable
Other-Screen Shot	Screenshot 2.png	Yes	Yes	Fillable Fileable
Other-Screen Shot	Screenshot 3.png	Yes	Yes	Fillable Fileable
Other-Screen Shot	Screenshot 4 - Mortgage ONLY.png	Yes	Yes	Fillable Fileable
Other-Screen Shot	Screenshot 4.png	Yes	Yes	Fillable Fileable
Other-Screen Shot	10.6.11 intake screenshot 1.1.png	Yes	Yes	Fillable Fileable
Other-Screen Shot	10.6.11 Mortgage intake screenshot 3.png	Yes	Yes	Fillable Fileable
Other-Screen Shot	10.6.11 Mortgage intake screenshot 5.png	Yes	Yes	Fillable Fileable
Other-Screen Shot	Steering Committee Mortgage intake screenshot 1.2.png	Yes	Yes	Fillable Fileable
Other-Screen Shot	Steering Committee Mortgage intake screenshot 1.png	Yes	Yes	Fillable Fileable
Other-Screen Shot	Steering Committee Mortgage intake screenshot 2.png	Yes	Yes	Fillable Fileable
Other-Screen Shot	Steering Committee Mortgage intake screenshot 4.png	Yes	Yes	Fillable Fileable
Other-Screen Shot	10.6.11 intake screenshot 1.1.png	Yes	Yes	Fillable Fileable
Other-Screen Shot	Steering Committee Mortgage intake screenshot 1.png	Yes	Yes	Fillable Fileable
Other-Screen Shot	Steering Committee Mortgage intake screenshot 1.2.png	Yes	Yes	Fillable Fileable
Other-Screen Shot	Steering Committee Mortgage intake screenshot 2.png	Yes	Yes	Fillable Fileable
Other-Screen Shot	Steering Committee Mortgage intake screenshot 4.png	Yes	Yes	Fillable Fileable
Other-Screen Shot	10.6.11 Mortgage intake screenshot 3.png	Yes	Yes	Fillable Fileable
Other-Screen Shot	10.6.11 Mortgage intake screenshot 5.png	Yes	Yes	Fillable Fileable
Other-Screen Shot	2.17.12 - 1 - Bank accounts and services.png	Yes	Yes	Fillable Fileable
Other-Screen Shot	2.17.12 - 1 - Student loan.png	Yes	Yes	Fillable Fileable
Other-Screen Shot	2.17.12 - 1 - Vehicle and consumer loans.png	Yes	Yes	Fillable Fileable
Other-Screen Shot	2.17.12 - 1.1 - Bank accounts and services.png	Yes	Yes	Fillable Fileable
Other-Screen Shot	2.17.12 - 1.1 - Student loan - Federal.png	Yes	Yes	Fillable Fileable
Other-Screen Shot	2.17.12 - 1.1 - Vehicle and consumer loans - vehicle loan, vehicle lease, installment loan.png	Yes	Yes	Fillable Fileable
Other-Screen Shot	2.17.12 - 1.2 - Student loan - Not sure.png	Yes	Yes	Fillable Fileable
Other-Screen Shot	2.17.12 - 1.2 - Vehicle and consumer loans - personal line of credit.png	Yes	Yes	Fillable Fileable
Other-Screen Shot	2.17.12 - 1.3 - Student loan - Non-federal.png	Yes	Yes	Fillable Fileable
Other-Screen Shot	2.17.12 - 2 - Bank accounts and services.png	Yes	Yes	Fillable Fileable
Other-Screen Shot	2.17.12 - 2 - Student loan.png	Yes	Yes	Fillable Fileable
Other-Screen Shot	2.17.12 - 2 - Vehicle and consumer loans.png	Yes	Yes	Fillable Fileable
Other-Screen Shot	2.17.12 - 3 - Bank accounts and services.png	Yes	Yes	Fillable Fileable
Other-Screen Shot	2.17.12 - 3 - Student loan.png	Yes	Yes	Fillable Fileable
Other-Screen Shot	2.17.12 - 3 - Vehicle and consumer loans.png	Yes	Yes	Fillable Fileable
Other-Screen Shot	2.17.12 - 4 - Bank accounts and services.png	Yes	Yes	Fillable Fileable
Other-Screen Shot	2.17.12 - 4 - Student loan.png	Yes	Yes	Fillable Fileable
Other-Screen Shot	2.17.12 - 4 - Vehicle and consumer loans.png	Yes	Yes	Fillable Fileable
Other-Screen Shot	2.17.12 - 5 - Bank accounts and services.png	Yes	Yes	Fillable Fileable
Other-Screen Shot	2.17.12 - 5 - Student loan.png	Yes	Yes	Fillable Fileable
Other-Screen Shot	2.17.12 - 5 - Vehicle and consumer loans.png	Yes	Yes	Fillable Fileable
Other-Screen Shot	2.17.12 - Universal confirmation page.png	Yes	Yes	Fillable Fileable
Other-Screen Shots	Screenshots for Debt Collection Complaint (July 2013).pdf	Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Economic Development

Subfunction: Industry Sector Income Stabilization

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2,250,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	2,250,000	2,250,000
Annual IC Time Burden (Hours)	262,500	262,500
Annual IC Cost Burden (Dollars)	0	0

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.