CFPB's Consumer Response Intake Form Improvement Study, Second Iteration (Intake Form Improvement Study II)

CFPB: Consumer Response CR3
Quota
 15 adults (18 years of age and older) who have had multiple issues with
a financial product or service in the past year.
o Issues refer to any problem/confusion/frustration that a
consumer might want to submit a complaint about.
 Financial products and services include:
o Mortgages
o Student loans
o Vehicle loans or leases
o Payday, title, and pawn loans
o Checking and savings accounts
o Credit cards
o Prepaid cards, payroll cards
o Credit Reporting
o Debt Collection
o Money transfers
o Other money services
 Recruit for a mix of gender, race, ethnicity, income, and education.
 Recruit at least 5 participants who have had an issue with a prepaid
card and/or payday, title, or pawn loans in the past year.
 Recruit at least 3 participants from Northern Mississippi
Participants

Location

15 adults who have had multiple
issues with a financial service or
product in the past year
5 participants who have
issues with prepaid card,
payday, title, or pawn
loans

Memphis, TN

3 participants from
Northern Mississippi

Recruitment Plan
 Recruitment will be conducted by the focus group facility.
 Participants’ information is reconfirmed upon arrival of interview.
 Participants are compensated $75 for the 60-minute session.

Web-Based Screener (NOTE: Items in grey are FMG standard recruiting items.)
Thank you for your interest in participating in user experience studies at [Insert name of
organization]. We are seeking participants to complete tasks and provide feedback on a website.
One-on-one interviews will be held [Insert dates] and will take place at our office in [Insert location]. If
you are interested in participating, please complete this questionnaire. If you qualify for this study,
we will contact you for further screening and to schedule you at a time that is convenient for you.
Compensation ($75) will be provided to those who participate in the study.
Paperwork Reduction Act Statement [Link to new window].
[Paragraph below in the new window]
Paperwork Reduction Act
According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor,
and a person is not required to respond to a collection of information unless it displays a
valid OMB control number. The OMB control number for this collection is 3170-0024. It
expires on 12/31/2015. The time required to complete this information collection is
estimated to average approximately 5 minutes per response. Responding to this collection of
information is voluntary. Comments regarding this collection of information, including the
estimated response time, suggestions for improving the usefulness of the information, or
suggestions for reducing the burden to respond to this collection should be submitted to
Bureau at the Consumer Financial Protection Bureau (Attention: PRA Office), 1700 G Street
NW, Washington, DC 20552, or by email to [email protected].

[Paragraph below included]
Privacy Act Statement
5 U.S.C. 552(a)(e)(3)
The information you provide through your responses to Fors Marsh will assist the study sponsor, the
Consumer Financial Protection Bureau (“CFPB”), in evaluating a prototype website that has financial
information.
The CFPB will not obtain or access any directly identifying information from Fors Marsh about study
participants. The agency will only obtain and access de-identified results and aggregated analyses of
those results.
Information collected on behalf of the Bureau by Fors Marsh will be treated in accordance with the
System of Records Notice (“SORN”), CFPB.021 – CFPB Consumer Education and Engagement
Records, 77 F.R. 60382. This information will not be disclosed as outlined in the Routine Uses for
the SORN. Direct identifying information will only be used by Fors Marsh to facilitate the study and
will be kept private except as required by law.
This collection of information is authorized by Pub. L. No. 111-203, Title X, Sections 1013 and 1022,
codified at 12 U.S.C. §§ 5493 and 5512.
Participation in this study is voluntary, you are not required to participate or share any identifying
information with Fors Marsh, including name and email address, and you may withdraw participation
at any time. However, if you do not include the requested information, you may not participate in the
study.
Thank you for your interest.
[The gray highlighted questions are standard FMG questions]
Q1.

First name: [Text box]

Q2.

Email [Text box]

Q3.

Mobile number: [Text box]

Q4.

Alternate number: [Text box]

Q5.

Date of birth: [Text box]

Q6.

What is your gender?
1. Male
2. Female

Last name: [Text box]

Q7. Are you of Hispanic, Latino, or Spanish origin?
1. No, not of Hispanic, Latino, or Spanish origin
2. Yes, Hispanic, Latino, or Spanish origin
Q8. Please select all of the following that best describe your race:
1. White
2. Black or African American
3. American Indian or Alaska Native
4. Asian
5. Native Hawaiian or Other Pacific Islander
Q9.

What city and state do you live in? [Text box]

Q10.

How often do you access the Internet? [Radio buttons, select only one]
1.
2.
3.
4.
5.

Q11.

20+ hours a week
10-20 hours a week
5-9 hours a week
1-4 hours a week
Hardly ever

Which device do you use the most to access the Internet? [Radio buttons, select only one]
1. Desktop or laptop computer
2. Tablet (For example, iPad, Nexus 7 or 9, Samsung Galaxy Tab, Kindle Fire)
3. Smartphone (For example, iPhone, HTC One, Samsung Galaxy S5, Nexus 4 or 5, Nokia
Lumia)
4. Other: [Please specify]

Q12. If you wanted to apply for a new credit card online, what type of device would you use?
[Check boxes, select all that apply]
1. Desktop or laptop computer
2. Tablet (For example, iPad, Nexus 7 or 9, Samsung Galaxy Tab, Kindle Fire)
3. Smartphone (For example, iPhone, HTC One, Samsung Galaxy S5, Nexus 4 or 5, Nokia
Lumia)
4. Other: [Please specify]

Q13. In the past year, have you had any issues with the following financial products and services?
[Check boxes, select all that apply]
1. Credit card
2. Prepaid card
3. Government benefit card or payroll card
4. Money transfer or money service
5. Mortgage
6. Student loan
7. Vehicle loan or lease
8. Payday, title, pawn, or installment loan
9. Debt collection
10. Credit reporting
11. Checking or savings account
11. Other: Please specify [Text box]
12. I haven’t had any issues with financial products or services
Q14. [For each instance Q13_1 – Q13_11 is selected] Tell us a little about the issue(s) you had
with… (Two to three sentences, please).
Q15.

What is the highest educational degree that you have earned? [Radio buttons, select only
one]
1. Less than high school degree or equivalent
2. High school graduate (grade 12, diploma, or GED)
3. Trade school certificate
4. Some college courses completed
5. Graduated with a 2 year degree (Associates)
6. Graduated with a 4 year degree (Bachelors)
7. Some graduate school courses completed
8. Graduated with a post-graduate degree

Q16.

Which of the following best describes what you are currently doing? [Check boxes, select all
that apply]
1. Going to high school
2. Going to community college, 2-year degree program, or trade school (either full-time or
part-time)
3. Going to a 4-year college/university (either full-time or part-time)
4. Working full-time
5. Working part-time
6. Homemaker
7. Retired
8. Not employed

Q17.

What is your occupation? [Text box]

Q18.

What industry do you work in? [Text box]

Q19.

What is your annual household income? [Radio buttons, select only one]
1. Less than $30K
2. $30K - $50K
3. $50K - $100K
4. $100 - $150K
5. More than $150K

Q20.

How did you hear about research opportunities with us?
1.
2.
3.
4.
5.
6.
7.
8.

Google
Facebook
Newspaper listing
Online newspaper listing
Craigslist.org
Restaurants or Cafes (e.g., Starbucks, Panera, Buzz Bakery)
Friend or Family
Other [Text box]

Thank you for completing this survey. The study is taking place December 5th, 6th, and 7th. We hope
to be in contact with you soon about scheduling a time for you to participate. If you have any
questions please contact us at [Insert email address] or call us at [Insert phone number]. You can
also visit our website at [Insert website address].

Phone-Based Screener (for those who qualify based on web-based screener)
Hello ______. Thank you for your interest in participating in user experience studies at Fors Marsh
Group. My name is ________ and I wanted to follow up regarding a web-based screener that you
completed recently for an upcoming study about a website. I wanted to ask a couple more questions
and see if we can schedule you. Your participation is completely voluntary. Do you have a few
minutes?
Q1. Can you please verify your age?
Q2. What is your current occupation?
Q3. Can you tell me a little about the issues you had with financial products and services? [Open
ended. Terminate if responses are inconsistent with web screener]
Invitation:
We would like to invite you to participate in our study. We will show you a financial website and ask
you to complete tasks using the website. The entire interview should last about an hour, and you will
be paid $75 in the form of a check when you are done. Would you be willing to participate in this
study?
Reconfirm participant’s email address.

Terminate message: both for web and phone screener
We are sorry but you do not qualify for this study. Would you like us to contact you for future studies
that you qualify for? [Radio buttons, select only one]
1. Yes
2. No