Information Collection

Consumer Response Intake Forms

IC 198358 under ICR 202012-3170-001 · OMB 3170-0011.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3170-0011 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Attachment 1.Inventory of Questions for the CFPB's CR Intake Form_FINAL.pdf	Other-Inventory of Questions
Attachment 1.Inventory of Questions for the CFPB's CR Intake Form_FINAL.pdf	Other-Inventory of Questions
Attachment 2.Consumer Response Intake Instruments_FINAL.pdf	Other-Intake Instruments
Attachment 2.Consumer Response Intake Instruments_FINAL.pdf	Other-Intake Instruments
Attachment 3.Net New Complaint Form Fields and Values_FINAL.xlsx	Other-Fields and Values
Attachment 3.Net New Complaint Form Fields and Values_FINAL.xlsx	Other-Fields and Values
Attachment 4.New Household and Income Questions_FINAL.pdf	Other-Household and Income Questions
Attachment 4.New Household and Income Questions_FINAL.pdf	Other-Household and Income Questions

IC Title:

Consumer Response Intake Forms

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Inventory of Questions	Yes	Yes	Fillable Fileable
Other-Intake Instruments	Yes	Yes	Fillable Fileable
Other-Fields and Values	Yes	Yes	Fillable Fileable
Other-Household and Income Questions	Yes	Yes	Fillable Fileable

Line of Business: Economic Development

Subfunction: Financial Sector Oversight

Privacy Act System of Records

Title: CFPB.005âConsumer Response System

FR Citation: 79 FR 21440

Number of Respondents: 3,000,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 75 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	3,000,000	3,000,000
Annual IC Time Burden (Hours)	387,500	387,500
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.

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