Consumer Response Intake Form

ICR 201407-3170-002

OMB: 3170-0011

Federal Form Document

Forms and Documents
Document
Name
Status
Justification for No Material/Nonsubstantive Change
2014-07-08
Justification for No Material/Nonsubstantive Change
2013-12-11
Justification for No Material/Nonsubstantive Change
2013-11-01
Supplementary Document
2013-10-23
Supplementary Document
2013-10-23
Justification for No Material/Nonsubstantive Change
2013-10-23
Justification for No Material/Nonsubstantive Change
2013-07-01
Justification for No Material/Nonsubstantive Change
2013-02-21
Justification for No Material/Nonsubstantive Change
2012-06-11
Justification for No Material/Nonsubstantive Change
2012-02-24
Supporting Statement A
2011-11-16
IC Document Collections
ICR Details
3170-0011 201407-3170-002
Historical Active 201312-3170-002
CFPB
Consumer Response Intake Form
No material or nonsubstantive change to a currently approved collection   No
Regular
Approved without change 07/16/2014
Retrieve Notice of Action (NOA) 07/08/2014
  Inventory as of this Action Requested Previously Approved
05/31/2015 05/31/2015 05/31/2015
3,000,000 0 3,000,000
387,500 0 387,500
0 0 0

The Intake Form is designed to aid consumers in the submission of complaints, questions, and comments and to help the CFPB fulfill the aforementioned statutory requirements. Consumers (hereinafter "respondents") will be able to complete and submit information through the Intake Form electronically on the CFPB's website. Alternatively, respondents may request that the CFPB email a fillable PDF version or, by telephone, request a "paper" copy of the Intake Form, and then email, mail, or fax it to the CFPB. The questions within the Intake Form prompt respondents for a description of, and key facts about, the complaint at issue, the desired resolution, contact and account information, information about the institution they are filing a complaint against, and any previous action taken to attempt to resolve the complaint. Responses to these questions will help document the substance of the complaint, question, or comment; information necessary to identify the subject incident, consumer, and institution; and contact information needed to follow-up on the complaint, question, or comment.

PL: Pub.L. 111 - 203 1013 Name of Law: Dodd–Frank Wall Street Reform and Consumer Protection Act
  
PL: Pub.L. 111 - 203 1013 Name of Law: Dodd–Frank Wall Street Reform and Consumer Protection Act

Not associated with rulemaking

  76 FR 13018 03/09/2011
76 FR 38458 06/30/2011
Yes

2
IC Title Form No. Form Name
Consumer Response Intake Form (Web)
Consumer Response Intake Form (Paper/Telephone) TDF 104.3 Consumer Response Intake Form

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 3,000,000 3,000,000 0 0 0 0
Annual Time Burden (Hours) 387,500 387,500 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

No
No
No
Yes
No
Uncollected
Darrin King 202-693-4129 [email protected]

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
07/08/2014


© 2024 OMB.report | Privacy Policy