Information Collection

Application and Related Forms

IC 204699 under ICR 201911-3170-002 · 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⚠️ Notice: This information collection may be referencing outdated material.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

Document Name Document Type
cfpb_OD_CAB_application_122319.pdf Other-CAB Application
cfpb_OD_CBAC_CUAC_application_122319.pdf Other-CBAC/CUAC Application
cfpb_OD_ARC_application_122319.pdf Other-ARC Application
3170-0037 Application to Serve as a Small Entity Representative OMB.pdf Other-SER Application
3170-0037 FINANCIAL DISCLOSURE Form OMB.pdf Other-Financial Disclosure
FBI Name Check Request - Advisory Committee OMB.docx Other-Name Check
3170-0037 CFPB Travel Information Form OMB.pdf Other-Travel Information

Information Collection (IC) Details

View Information Collection (IC)

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:

Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Name Check	FBI Name Check Request - Advisory Committee OMB.docx	Yes	Yes	Fillable Fileable
Other-Travel Information	3170-0037 CFPB Travel Information Form OMB.pdf	Yes	Yes	Fillable Fileable
Other-CBAC/CUAC Application	cfpb_OD_CBAC_CUAC_application_122319.pdf	Yes	Yes	Fillable Fileable
Other-CAB Application	cfpb_OD_CAB_application_122319.pdf	Yes	Yes	Fillable Fileable
Other-ARC Application	cfpb_OD_ARC_application_122319.pdf	Yes	Yes	Fillable Fileable
Other-SER Application	3170-0037 Application to Serve as a Small Entity Representative OMB.pdf	Yes	Yes	Fillable Fileable
Other-Financial Disclosure	3170-0037 FINANCIAL DISCLOSURE Form OMB.pdf	Yes	Yes	Fillable Fileable

Line of Business: Economic Development

Subfunction: Financial Sector Oversight

Privacy Act System of Records
Title: CFPB.016: CFPB Advisory Boards and Committees	FR Citation: 83 FR 23435

Number of Respondents: 425	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 80 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	735	735
Annual IC Time Burden (Hours)	491	491
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.