IC Request Form for CR Usability Survey

CONSUMER FINANCIAL PROTECTION BUREAU (CFPB)
REQUEST FOR APPROVAL UNDER THE GENERIC CLEARANCE
FOR CONSUMER COMPLAINT AND INFORMATION COLLECTION SYSTEM
(TESTING AND FEEDBACK)
(OMB Control Number: 3170-0042)

1. TITLE OF INFORMATION COLLECTION: Usability Test for Consumer Satisfaction
Survey of the CFPB Consumer Complaint Intake Form

2. PURPOSE: The purpose of this information collection is to test the usability of a survey
vehicle designed to gather consumer perceptions of the CFPB Consumer Complaint Intake Form
that will be deployed as a consumer satisfaction survey nationwide.

3. DESCRIPTION OF RESPONDENTS: The targeted group of respondents is a randomly
selected sample of individual consumers who have had a CFPB complaint case closed within the
previous three months and for whom CFPB has an email address.
To achieve a target of 20 completed responses, the survey will be distributed to approximately
200 potential respondents via email, estimating a standard completion rate of 10 percent and
accounting for instances of email bounce-back and survey abandonment based on experiential
data.
The survey will be completely voluntary, and all results will be aggregated.

4. TYPE OF COLLECTION: (Check all that apply)
[X] Customer Satisfaction Survey
[ ] Piloting Revisions to Consumer Complaint Form
[ ] Focus group
[X] Usability or laboratory test (not in live system)
[X] Web-based
[ ] Other (describe) ___________________
5. 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
If Yes, please provide Federal Register citation. __ __N/A_____.

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6. GIFTS OR PAYMENTS: Incentives will not be offered to respondents of the collection of
information approved under this generic information collection plan.

7. BURDEN HOURS:
Category of Respondent

Number of
Respondents

Individuals or Households
Totals

Participation
Time
(hours)
20
.17
20 /////////////////////

Burden
(hours)

8. FEDERAL COST: The estimated annual cost to the Federal government is
$______23,305.66______. The total fee for the survey project is $23,056.58. Ten percent of
this fee is allocated to this usability phase of the project. Ninety percent of this fee is allocated to
the remainder of the project in national deployment.

9. DURATION OF TEST: The duration of the test is 20 responses and not to exceed 6 days.

10. CERTIFICATION:
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.
 Information gathered will not be used solely 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.
 Test questions will not exceed the durations specified herein and will only be made
permanent through standard clearance procedures.

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