Financial Assessment, Counseling, and Follow-up

Notice of Collection Under the Privacy Act of 1974, 5 U.S.C. § 552a -- As
Amended
(Privacy Act Statement)

The information requested is being collected to assist in providing you with financial
counseling. The Consumer Financial Protection Bureau (CFPB) will not obtain or access any
information that directly identifies participants, and any answers you provide will not be tied to
you individually. The agency will only obtain and access de-identified results and aggregated
analyses of those results.
The collection of this information is authorized by Public Law 111-203, Title X, Sections
1013 and 1022, codified at 12 U.S.C. 5493 and 5512. The information is collected pursuant
to the CFPB’s published Privacy Act system of records notice CFPB.021 – Consumer
Education and Engagement Records although no identifiable information will be disclosed

Participation in this program is entirely voluntary and you are not required to submit or
provide any identifying information; however, if you choose not to provide the information,
we may not be able to provide you the requested financial counseling.

Paperwork Reduction Statement
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-XXXX. It
expires on MM/DD/YYYY. The time required to complete this information collection is
estimated to average approximately 2 hours for the financial assessment and in-person
follow-up ; 1 hour for creating a budget and action plan; and 12 minutes for an electronic
follow-up. 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].