Application Forms

Application Forms for Financial Empowerment Partnerships

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3170-0068 can be found here:

Documents and Forms

Document Name Document Type
cfpb_financial_coaching_initiative_form_r2-1.pdf Other-Application for Financial Coac
cfpb_tax_assistance_program_form_r2-1.pdf Other-Application for Tax Assistance
cfpb_ymyg_ cohort_application_r4-1.pdf Other-Application for YMYG Cohort

Information Collection (IC) Details

IC Title:	Application Forms	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Application for YMYG Cohort	cfpb_ymyg_ cohort_application_r4-1.pdf	Yes	Yes	Fillable Fileable
Other-Application for Financial Coaching Initiative	cfpb_financial_coaching_initiative_form_r2-1.pdf	Yes	Yes	Fillable Fileable
Other-Application for Tax Assistance Program	cfpb_tax_assistance_program_form_r2-1.pdf	Yes	Yes	Fillable Fileable

Line of Business: Economic Development

Subfunction: Financial Sector Oversight

Privacy Act System of Records
Title: CFPB.021 CFPB Consumer Education and Engagement Records, 77 F.R. 60382	FR Citation: 77 FR 60382

Number of Respondents: 285	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	325	325
Annual IC Time Burden (Hours)	1,625	1,625
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.