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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
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

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:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.