IC Template

Request for Approval under the “Generic Clearance for the Collection of
Qualitative Feedback on the Service Delivery of the Consumer Financial
Protection Bureau” (OMB Control Number: 3170-0024)
1. TITLE OF INFORMATION COLLECTION: Money Smart for Older Adults Train-theTrainer Session Feedback Form and Money Smart for Older Adults Participant Evaluation
Form.

PURPOSE: To assess how trainers view the effectiveness of the Money Smart for Older
Adults (MSOA) train-the-trainer curriculum and to survey how MSOA session participants
view the effectiveness of the training curriculum. With respect to the train-the-trainer
curriculum, feedback is particularly being sought on: the clarity of the information presented;
the instructor’s comfort level with teaching the curriculum; how the curriculum will be used; if
the instructor’s would recommend the curriculum to other potential instructors; and how likely
they are to use the curriculum to train more clients. With respect to participants, the evaluation
form provides trainers a way to assess their impact on participants’ knowledge of financial
exploitation, and gather feedback on the quality and effectiveness of the materials, the training
and the instructor.
2. DESCRIPTION OF RESPONDENTS: For the MSOA Train-the-Trainer Session Feedback
Form respondents will include individuals representing adult social service agencies, law
enforcement, financial services, legal professionals and retired professionals from diverse
backgrounds who have participated in a MSOA train-the-trainer program online or in a face-toface session. For the Participant Evaluation Form respondents will include older adults aged
62+, family caregivers, senior advocates and financial service representatives who have
received the presentation of the MSOA consumer training program.

3. TYPE OF COLLECTION (ADMINISTRATION OF THE INSTRUMENT):
a.

How will you collect the information? (Check all that apply)
[ ] Web-based or other forms of Social Media
[ ] Telephone
[X] In-person
[ ] Mail
[ ] Small Discussion Group
[ ] Focus Group
[X] Other, Explain:
Data will be provided to the CFPB in
aggregate by community stakeholders
who will collect the data directly from
respondents.

b. Will interviewers or facilitators be used?
[ ] Yes [x] No [ ] Not Applicable

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4. FOCUS GROUP OR SURVEY:
If you plan to conduct a focus group or survey, please provide answers to the following
questions:
a. Do you have a customer list or something similar that defines the universe of potential
respondents and do you have a sampling plan for selecting from this universe?
[X] Yes [ ] No [ ] Not Applicable
b. If the answer is yes, please provide a description below. If the answer is no, please
provide a description of how you plan to identify your potential group of respondents and
how you will select them? The surveys will be given to individuals who have participated in
either the MSOA train-the-trainer session or who have received an MSOA presentation.
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, has a System or Records Notice (SORN) been published?
[X ] Yes [ ] No [ ] Not Applicable
If Yes, provide Federal Register citation for the CFPB.021 Consumer Education and
Engagement Records SORN 79 FR 78839.
c. If applicable, what is the link to the Privacy Impact Assessment (PIA)?
Consumer Experience Research PIA,
http://files.consumerfinance.gov/f/201406_cfpb_consumer-experienceresearch_pia.pdf
6. INCENTIVES:
a. Is an incentive provided to participants? [ ] Yes [ X] No
b. If Yes, provide the amount or value of the incentive? $ N/A
c. If Yes, provide a statement justifying the use and amount of the incentive N/A
7. BURDEN ESTIMATES:
Information Collection

Number of
Frequency
Respondents

Train-the-Trainer Session Feedback Form
Participant Evaluation Form
Totals

3000
1
7000
1
10,000 ///////////////////

Number of
Annual
Responses

Response
Time
(hours)

Burden
Hours

3000
.05
7000
.08
10,000 /////////////////////////

8. FEDERAL COST: The estimated annual cost to the Federal government is

150
583
733

$0
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9. CERTIFICATIONS:
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:
(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
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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