Information Collection

Student Loan Repayment Loan Form Testing

IC 223202 under ICR 201512-3170-001 · OMB 3170-0022.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3170-0022 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Payback Playbook Testing Discussion Guide - OMB.pdf	Other-Discussion Guide
Payback Playbook Disclosure Forms_1_and2_ - OMB.pdf	Other-Disclosure Form
Payback Playbook_WaitingRoomWorksheet - OMB.pdf	Other-Worksheet
CFPB TO16_Student Loans Form Testing Screener - OMB.pdf	Other-Screeners
IC Template 3170-0022 (Student Loan Repayment Disclosure Testing) -OMBL.pdf Supporting Statement	IC Document

IC Title:

Student Loan Repayment Loan Form Testing

Agency IC Tracking Number:

10786

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Discussion Guide	Payback Playbook Testing Discussion Guide - OMB.pdf		No		Paper Only
Other-Disclosure Form	Payback Playbook Disclosure Forms_1_and2_ - OMB.pdf		No		Paper Only
Other-Worksheet	Payback Playbook_WaitingRoomWorksheet - OMB.pdf		No		Paper Only
Other-Screeners	CFPB TO16_Student Loans Form Testing Screener - OMB.pdf	NA	Yes	Yes	Fillable Fileable

Line of Business: Economic Development

Subfunction: Financial Sector Oversight

Privacy Act System of Records

Title: CFPB 021 Consumer Education and Engagement Records

FR Citation: 79 FR 78839

Number of Respondents: 100

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 73 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	234	234
Annual IC Time Burden (Hours)	44	44
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Supporting Statement	IC Template 3170-0022 (Student Loan Repayment Disclosure Testing) -OMBL.pdf	08/25/2016

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.