Information Collection

Application for Non-Profit Budget and Credit Counseling Agencies

IC 11781 under ICR 201604-1105-002 · OMB 1105-0084.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1105-0084 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Application for Non-Profit Budget and Credit Counseling Agencies	Form
2016 CC Application Instructions.docx	Instruction
APPLICATION FOR APPROVAL AS A NONPROFIT BUDGET AND CREDI 2016 CC Application.docx	Form
Appendix A: Acknowledgments, Agreements, and Declaration CC Appendix A.doc	Form
Appendix B: Judicial Districts CC Appendix B.docx	Form
Appendix C: Business Locations CC Appendix C.doc	Form
Appendix D: Matrix of Current Counselors CC Appendix D.doc	Form
Appendix E: Activity Report for Approved Credit Counseli CC Appendix E.doc	Form

IC Title:

Application for Non-Profit Budget and Credit Counseling Agencies

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	NA	APPLICATION FOR APPROVAL AS A NONPROFIT BUDGET AND CREDIT COUNSELING AGENCY	2016 CC Application.docx	Yes	Yes	Printable Only
Form	NA	Appendix A: Acknowledgments, Agreements, and Declarations in Support of Application for Approval as a Nonprofit Budget and Credit Counseling Agency	CC Appendix A.doc	Yes	Yes	Fillable Printable
Form	NA	Appendix B: Judicial Districts	CC Appendix B.docx	Yes	Yes	Fillable Fileable
Form	NA	Appendix C: Business Locations	CC Appendix C.doc	Yes	Yes	Fillable Fileable
Form	NA	Appendix D: Matrix of Current Counselors	CC Appendix D.doc	Yes	Yes	Fillable Fileable
Form	NA	Appendix E: Activity Report for Approved Credit Counseling Agencies	CC Appendix E.doc	Yes	Yes	Fillable Printable
Instruction			2016 CC Application Instructions.docx	Yes	No	Fillable Fileable

Line of Business: General Government

Subfunction: Executive Functions

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 122

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	122	-53	175
Annual IC Time Burden (Hours)	560	-248	808
Annual IC Cost Burden (Dollars)	6,100	-2,650	8,750

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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