Information Collection

Customer Complaint Form

IC 20142 under ICR 202010-1557-002 · OMB 1557-0232.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1557-0232 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Customer Complaint Form	Form and Instruction
Privacy Act Statement changes for OMB approval.docx	Other-Privacy Act Statement
Customer Complaint Form complaint-2019.pdf	Form and Instruction
Consumer Complaint Form Consumer Complaint Form with Revisions.docx	Form

IC Title:

Customer Complaint Form

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	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	N/A	Customer Complaint Form	complaint-2019.pdf	Yes	Yes	Fillable Fileable Signable
Form	N/A	Consumer Complaint Form	Consumer Complaint Form with Revisions.docx	Yes	Yes	Fillable Fileable Signable
Other-Privacy Act Statement			Privacy Act Statement changes for OMB approval.docx	Yes	No	Printable Only

Line of Business: Economic Development

Subfunction: Financial Sector Oversight

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 10,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 45 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	10,000	10,000
Annual IC Time Burden (Hours)	830	830
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.