Information Collection

Application for Non-Profit Budget and Credit Counseling Agencies

IC 11781 under ICR 201910-1105-002 · 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⚠️ Notice: This information collection may be referencing outdated material.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

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
Revision 10.16.201 APPLICATION FOR APPROVAL AS A NONPROFIT BUDGET AND CREDI 1105-0084 Collection Instrument.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

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:

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
Form and Instruction	Revision 10.16.2019 1105-0084	APPLICATION FOR APPROVAL AS A NONPROFIT BUDGET AND CREDIT COUNSELING AGENCY	1105-0084 Collection Instrument.pdf	Yes	No	Fillable Printable

Line of Business: General Government

Subfunction: Executive Functions

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 86	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	86	-36	122
Annual IC Time Burden (Hours)	362	-198	560
Annual IC Cost Burden (Dollars)	4,300	-1,800	6,100

Documents for IC

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