3170-0032 IC Submission Template

BUREAU OF CONSUMER FINANCIAL PROTECTION

Request for Approval under the Generic INFORMATION COLLECTION PLAN FOR THE

Compliance Costs and Other Effects of Regulations

(OMB Control Number: 3170-0032)

PART A: JUSTIFICATION FOR THE INFORMATION COLLECTION

1. TITLE OF INFORMATION COLLECTION:

2. PURPOSE:

3. DESCRIPTION OF RESPONDENTS:

4. Federal Register Notice Citations:

1. 60-day Federal Register Notice 84 FR 26078 Date: 06/5/2019

2. 30-day Federal Register Notice __ FR ______ Date: __________

3. Comments received in response to the 30-day Notice: [ ] Yes [ ] No

4. If yes, summarize the comments and the Bureau’s response to those comments:

5. TYPE OF COLLECTION (Administration of the instrument):

1. How will you collect the information? (Check all that apply)

[ ] Web-based or other forms of Social Media [ ] Telephone

[ ] In-person [ ] Mail

[ ] Small Discussion Group [ ] _{Focus Group} [ ] Other, Explain ______________________

2. Will interviewers or facilitators be used?

[ ] Yes [ ] No [ ] Not Applicable

6. Personally Identifiable Information:

1. I Is personally identifiable information (PII) collected? [ ] Yes [ ] No

2. If Yes, is the information that will be collected included in records that are subject to the Privacy Act of 1974? [ ] Yes [ ] No [ ] Not Applicable

If applicable, what is the link to the Privacy Impact Assessment?

3. If Applicable, has a System or Records Notice (SORN) been published?

[ ] Yes [ ] No [ ] Not Applicable

If yes, provide the title and Federal Register citation for the SORN. Title:___________________________________

___ FR _______________.

7. INCENTIVES:

1. Is an incentive provided to participants? [ ] Yes [ ] No

2. If Yes, provide the amount or value of the incentive? $___________.

3. If Yes, provide a statement justifying the use and amount of the incentive.

8. BURDEN HOURS

Collection of Information	Number of Respondents	Responses per Respondent (Frequency)	Number of Responses	Participation Time (hours)	Burden Hours
[Insert Rows as Needed]
Totals:		//////////////////////		////////////////////

9. FEDERAL COST: The estimated annual cost to the Federal government is $ ____________.

PART B: COLLECTIONS OF INFORMATION EMPLOYING STATISTICAL METHODS OR CONDUCTING A SURVEY OF FOCUS GROUP

If you are conducting a focus group, survey, or plan to employ statistical methods, please provide answers to the following questions:

1. Respondent Universe and Selection Methods

1. Do you have a customer list or something similar that defines the universe of potential respondents and do you have a sampling plan for selecting from this universe?

[] Yes [] No

2. If the answer is Yes, please provide a description below (or attach the sampling plan). If the answer is No, please provide a description of how you plan to identify your potential group of respondents and how you will select them.

3. The selection of your targeted respondents. Provide a description of how you plan to identify your potential group of respondents and how you will select them.

2. Information Collection Procedures

3. Methods to Maximize Response Rates and Address Issues of Non-Response

4. Testing of Procedures or Methods

5. Contact Information for Statistical Aspects of the Design

PART C: CERTIFICATIONS

CERTIFICATION PURSUANT TO 5 CFR 1320.9, AND THE RELATED PROVISIONS OF 5 CFR 1320.8(b)(3) :

By submitting this document, the Bureau certifies the following to be true:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It uses plain, coherent, and unambiguous terminology that is understandable to respondents;

(d) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(e) It indicates the retention period for recordkeeping requirements;

(f) It informs respondents of the information called for under 5 CFR 1320.8(b)(3):

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(g) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected;

(h) It uses effective and efficient statistical survey methodology; and

(i) It makes appropriate use of information technology.

CERTIFICATION FOR INFORMATION COLLECTIONS SUBMITTED UNDER THIS GENERIC INFORMATION COLLECTION PLAN

By submitting this document, the Bureau certifies the following to be true:

• The collection is voluntary.

• The collection is low-burden for respondents and low-cost for the Federal Government.

• The collection is non-controversial and does not raise issues of concern to other federal agencies.

• Information gathered will not be used solely for the purpose of substantially informing influential policy decisions.

• The collection is targeted to the solicitation of opinions from respondents who have experience with the program or may have experience with the program in the future.

• The results will not be used to measure regulatory compliance or for program evaluation.

8