Information Collection

Customer Complaint Form

IC 20142 under ICR 202101-1557-004 · 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⚠️ Notice: This information collection may be referencing outdated material.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

Document Name Document Type
Privacy Act Statement changes for OMB approval.docx Other-Privacy Act Statement
Privacy Act Statement changes for OMB approval.docx Other-Privacy Act Statement
Declaracion de la Ley de Privacidad customer-complaint-form-spanish.pdf Form
Declaracion de la Ley de Privacidad customer-complaint-form-spanish.pdf Form
Customer Complaint Form customer-complaint-form.pdf Form
Customer Complaint Form customer-complaint-form.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

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:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Privacy Act Statement			Privacy Act Statement changes for OMB approval.docx	Yes	No	Printable Only
Form	N/A	Declaracion de la Ley de Privacidad	customer-complaint-form-spanish.pdf	Yes	Yes	Fillable Fileable Signable
Form	N/A	Customer Complaint Form	customer-complaint-form.pdf	Yes	Yes	Fillable Fileable Signable

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 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	10,000	0	10,000
Annual IC Time Burden (Hours)	3,300	2,470	830
Annual IC Cost Burden (Dollars)	0	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.