Information Collection

Survey Materials

IC 207968 under ICR 201307-3170-007 · OMB 3170-0043.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Appendix A - Survey Question Item Bank.pdf	Other-Survey Questions
CFPB Financial Metrics Formatted Survey for Wave 1 Pilot 4-15.pdf	Other-Survey
Appendix B - Survey Invitations.pdf Survey Invitations	IC Document
Appendix C - Informed Consent Statement.pdf Informed Consent	IC Document
Appendix D - SSI Privacy Policy.pdf SSI Privacy Policy	IC Document
Appendix E--Preliminary Validation Items.pdf Appendix E--Preliminary Validation Items	IC Document

IC Title:

Survey Materials

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Survey Questions			Appendix A - Survey Question Item Bank.pdf		Yes	Yes	Fillable Fileable
Other-Survey			CFPB Financial Metrics Formatted Survey for Wave 1 Pilot 4-15.pdf		Yes	Yes	Fillable Fileable

Line of Business: Economic Development

Subfunction: Financial Sector Oversight

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 16,500

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	16,500	16,500
Annual IC Time Burden (Hours)	4,625	4,625
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Survey Invitations	Appendix B - Survey Invitations.pdf	12/17/2013
Informed Consent	Appendix C - Informed Consent Statement.pdf	12/17/2013
SSI Privacy Policy	Appendix D - SSI Privacy Policy.pdf	12/17/2013
Appendix E--Preliminary Validation Items	Appendix E--Preliminary Validation Items.pdf	06/05/2014

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