Information Collection

Application and Related Forms

IC 204699 under ICR 201607-3170-001 · OMB 3170-0037.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3170-0037 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Application to Serve as a Small Entity Representative 4_6.pdf	Other-Application to Serve as a Smal
cfpb_OD_ARC_Application_040616.pdf	Other-ARC Application
cfpb_OD_CAB_Application_040616.pdf	Other-CAB Application
cfpb_OD_CBAC_CUAC_Application_040616.pdf	Other-CBAC CUAC Application
CFPB Travel Information Form.pdf	Other-CFPB Travel Form
TSA Travel Information Form 4_6.pdf	Other-TSA Travel Form
FBI Name Check Form 4_6.pdf	Other-FBI Name Check Form
Consumer Advisory Board Member Survey 4_6.pdf	Other-CAB Member Survey

IC Title:

Application and Related Forms

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Application to Serve as a Small Entity Rep	Application to Serve as a Small Entity Representative 4_6.pdf	Yes	Yes	Fillable Fileable
Other-ARC Application	cfpb_OD_ARC_Application_040616.pdf	Yes	Yes	Fillable Fileable
Other-CAB Application	cfpb_OD_CAB_Application_040616.pdf	No		Fillable Fileable
Other-CBAC CUAC Application	cfpb_OD_CBAC_CUAC_Application_040616.pdf	Yes	Yes	Fillable Fileable
Other-CFPB Travel Form	CFPB Travel Information Form.pdf	Yes	Yes	Fillable Fileable
Other-TSA Travel Form	TSA Travel Information Form 4_6.pdf	Yes	Yes	Fillable Fileable
Other-FBI Name Check Form	FBI Name Check Form 4_6.pdf	Yes	Yes	Fillable Fileable
Other-CAB Member Survey	Consumer Advisory Board Member Survey 4_6.pdf	Yes	Yes	Fillable Fileable

Line of Business: Economic Development

Subfunction: Financial Sector Oversight

Privacy Act System of Records

Title: Advisory Boards and Committees

FR Citation: 77 FR 12034

Number of Respondents: 425

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 80 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	805	-895	1,700
Annual IC Time Burden (Hours)	503	-772	1,275
Annual IC Cost Burden (Dollars)	0	0	0

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.