Information Collection

Financial Well-Being Cognitive Testing

IC 255219 under ICR 201909-3170-002 · OMB 3170-0055.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3170-0055 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
3170-0055 (Interview Questions).docx	Other-interview questions
3170-0055 (Email and Screener).docx	Other-introductory email and screene
3170-0055 supporting statement.docx 3170-0055 supporting statement	IC Document

IC Title:

Financial Well-Being Cognitive Testing

Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-interview questions			3170-0055 (Interview Questions).docx		No		Printable Only
Other-introductory email and screener questions			3170-0055 (Email and Screener).docx		Yes	Yes	Fillable Fileable

Line of Business: Economic Development

Subfunction: Financial Sector Oversight

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 263

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	263	263
Annual IC Time Burden (Hours)	112	112
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
3170-0055 supporting statement	3170-0055 supporting statement.docx	08/09/2022

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