Customer Complaint Form

Forms and Documents

Document Name	Status
Customer Complaint Form Form and Instruction	Modified
Consumer Complaint Form Justification.docx Justification for No Material/Nonsubstantive Change	2020-10-29
1557-0232 Supporting Statement 3-12-18.docx Supporting Statement A	2019-05-16
PIA.docx Supplementary Document	2018-03-12

IC Document Collections

IC ID	Document Title	Status
20142	Customer Complaint Form Form and Instruction	Modified

ICR Details

OMB Control No: 1557-0232	ICR Reference No: 202010-1557-008
Status: Active	Previous ICR Reference No: 202010-1557-002
Agency/Subagency: TREAS/OCC	Agency Tracking No:
Title: Customer Complaint Form
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 10/30/2020
	Date Received in OIRA: 10/29/2020
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2021	06/30/2021	06/30/2021
Responses	10,000	0	10,000
Time Burden (Hours)	830	0	830
Cost Burden (Dollars)	0	0	0

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Abstract: The Customer Complaint Form was developed as a courtesy for those who contact the OCC's Customer Assistance Group and wish to file a formal, written complaint. This non-material change involves adding the approved Privacy Act Statement to the Spanish Language translation of the form.

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Authorizing Statute(s): US Code: 15 USC 57a(f)(1) Name of Law: The Federal Trade Commission Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	83 FR 4959	02/02/2018
30-day Notice:	Federal Register Citation:	Citation Date:
	83 FR 21339	05/09/2018
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Customer Complaint Form	N/A, N/A, N/A, N/A, N/A	Customer Complaint Form ,   Consumer Complaint Form ,   Customer Complaint Form - Spanish Translation ,   Customer Complaint Form - Spanish - Marked ,   Declaracion de la Ley de Privacidad

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ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	10,000	10,000	0	0	0	0
Annual Time Burden (Hours)	830	830	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: The decrease in burden is due to the decrease in the number of forms being filed.

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Annual Cost to Federal Government: $0

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

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

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

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

(f) It indicates the retention periods for recordkeeping requirements;

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

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

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

(h) 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.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 10/29/2020

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