Survey Materials

Development of Metrics to Measure Financial Well-being of Working-age and Older American Consumers

Documents and Forms

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

Information Collection (IC) Details

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:

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 %

	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

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.