IC Template

CONSUMER FINANCIAL PROTECTION BUREAU
REQUEST FOR APPROVAL UNDER THE GENERIC CLEARANCE
FOR CONSUMER COMPLAINT AND INFORMATION COLLECTION SYSTEM
(TESTING AND FEEDBACK)
(OMB Control Number: 3170-0042)

1. TITLE OF INFORMATION COLLECTION: Consumer Financial Protection Bureau’s
(CFPB) Consumer Response Intake Form Improvement Study

2. PURPOSE: The CFPB will be collecting information for the improvement of the “Submit a
Complaint” intake form (available at www.consumerfinance.gov/complaint), an approved
collection registered as the Consumer Response Intake Form (Intake Form) (OMB Control No.
3170-0011 1).
The intake form is designed to aid consumers in the submission of complaints. Consumers are
able to complete and submit information electronically through the CFPB’s website or they may
submit information by telephone, mail, email, and fax.
The proposed study is designed to help the CFPB better understand the complexities associated
with consumers’ identification of financial products or services especially when problems are
layered. The test aims to determine the best method to assess the primary issues underlying
consumers’ complaints. In exploring the possibility of adding new values to the CFPB’s intake
form, we seek to test these new items in a live environment prior to making permanent changes
to our collection vehicle. By comparing historical consumer complaint data and web analytics to
the future state test data, the CFPB seeks to refine the products and associated issues contained
within the intake form to ensure their accurate representation of the consumer financial
marketplace.
This collection is the third iteration of the improvement study (see OMB No. 3170-0042 Notice
of Action 9/22/2014) designed to expand the participant pool based on internet literacy levels
and internet accessibility, to test system enhancements, and to address minor deficiencies
uncovered by the first and second iteration. The CFPB will return to the Office of Management
and Budget (OMB) for full review and guidance related to any items deemed necessary to
permanently include in consumer complaint web form.

3. DESCRIPTION OF RESPONDENTS:
Members of the general public who seek to submit a complaint about a financial product or
service via the CFPB’s complaint intake process.

4. TYPE OF COLLECTION: (Check all that apply)
[ ] Customer Satisfaction Survey

[x] Piloting Revisions to Consumer Complaint Form

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OMB Control No. 3170-0011 covers the approved collection registered as the Consumer Complaint Intake Form.
The intake form is designed to aid consumers in the submission of complaints, questions, and comments and to help
the Consumer Financial Protection Bureau (CFPB) fulfill the CFPB's statutory requirements.

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[ ] Focus group
[x] Web-based

[ ] Usability or laboratory test (not in live system)
[ ] Other (describe) ___________________

5. PERSONALLY IDENTIFIABLE INFORMATION:
a. Is personally identifiable information (PII) collected? [x] Yes [ ] No
b. If Yes, is the information that will be collected included in records that are subject
to the Privacy Act of 1974? [x ] Yes [ ] No [ ] Not Applicable
If applicable, what is the link to the Privacy Impact Assessment (PIA)?
http://files.consumerfinance.gov/f/201303_CFPB_PIA-Consumer-Response-System.pdf

c. If Applicable, has a System of Records Notice (SORN) been published?
[x ] Yes [ ] No [ ] Not Applicable
If Yes, provide Federal Register citation:
https://www.federalregister.gov/documents/2014/04/16/2014-08555/privacy-act-of-1974-asamended; 79 FR 21440

6. GIFTS OR PAYMENTS:
Incentives will not be offered to respondents of the collection of information approved under this
generic information collection plan.

7. BURDEN HOURS:
Information Collection

Web
Paper/Telephone
Totals

Number of
Respondents

Frequency

94,302
15,939
110,241

Number of
Annual
Responses
1x
1x

-

Response
Time
(hours)

94,302
15,939
-

Burden
Hours

0.2667
0.1667
-

8. FEDERAL COST: The estimated annual cost to the Federal government is $ ___________
The Consumer Response contract that covers the cost associated with the intake form
development also includes numerous other technology improvement projects and cannot be
accurately parsed to account just for form related improvements.

9. DURATION OF TEST: Six months.

10. CERTIFICATION:
CERTIFICATION PURSUANT TO 5 CFR 1320.9, AND THE RELATED PROVISIONS
OF 5 CFR 1320.8(b)(3) :
By submitting this document, the Bureau certifies the following to be true:

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25,150
2,657
27,807

(a) It is necessary for the proper performance of agency functions;
(b) It avoids unnecessary duplication;
(c) It uses plain, coherent, and unambiguous terminology that is understandable to
respondents;
(d) Its implementation will be consistent and compatible with current reporting and
recordkeeping practices;
(e) It indicates the retention period for recordkeeping requirements;
(f) It informs respondents of the information called for under 5 CFR 1320.8(b)(3):
(i) Why the information is being collected;
(ii) Use of information;
(iii) Burden estimate;
(iv) Nature of response (voluntary);
(v) Nature and extent of confidentiality; and
(vi) Need to display currently valid OMB control number;
(g) It was developed by an office that has planned and allocated resources for the efficient
and effective management and use of the information to be collected;
(h) It uses effective and efficient statistical survey methodology; and
(i) It makes appropriate use of information technology.

CERTIFICATION FOR INFORMATION COLLECTIONS SUBMITTED UNDER A
GENERIC INFORMATION COLLECTION PLAN
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By submitting this document, the Bureau certifies the following to be true:
The collection is voluntary.
The collection is low-burden for respondents and low-cost for the Federal Government.
The collection is non-controversial and does not raise issues of concern to other federal
agencies.
The results are not intended to be disseminated to the public.
Information gathered will not be used for the purpose of substantially informing influential
policy decisions.
The collection is targeted to the solicitation of opinions from respondents who have
experience with the program or may have experience with the program in the future.
The data collection is not statistically significant, the sample is not intended to be
representative, and the results will not be used to make inferences beyond the survey
sample.
The results will not be used to measure regulatory compliance or for program
evaluation.

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