Information Collection

Consumer Response Intake Form Improvement Study

IC 213163 under ICR 201307-3170-002 · OMB 3170-0042.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3170-0042 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
2014_9_18_Screening Questionnaire for Study Participation ICR 3170-0042_Revised.pdf	Other-Screener
CR1_UX Study_Informed Consent_2014-9-16.pdf	Other-Informed Consent
IC 3170-0042 Study CR1_Moderator's Guide_2014-9-15.pdf	Other-Moderator's Guide
IC Form 3170-0042 Usability Testing Screening Questionnaires and Study Revised.pdf IC Form CR UX Study	IC Document

IC Title:

Consumer Response Intake Form Improvement Study

Agency IC Tracking Number:

TI 10307

IC Status: New

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-Informed Consent	CR1_UX Study_Informed Consent_2014-9-16.pdf	Yes	Yes	Fillable Fileable
Other-Moderator's Guide	IC 3170-0042 Study CR1_Moderator's Guide_2014-9-15.pdf	Yes	Yes	Fillable Fileable
Other-Screener	2014_9_18_Screening Questionnaire for Study Participation ICR 3170-0042_Revised.pdf	Yes	Yes	Fillable Fileable

Line of Business: Economic Development

Subfunction: Financial Sector Oversight

Privacy Act System of Records

Title: CFPB Consumer Education and Engagement Records

FR Citation: 77 FR 60382

Number of Respondents: 250

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	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	302	302
Annual IC Time Burden (Hours)	27	27
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
IC Form CR UX Study	IC Form 3170-0042 Usability Testing Screening Questionnaires and Study Revised.pdf	09/18/2014

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.