Information Collection

Customer Complaint Form

IC 20142 under ICR 202107-1557-002 · 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⚠️ Notice: This information collection may be referencing outdated material.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
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 Spanish Form.pdf	Form
Declaracion de la Ley de Privacidad Spanish Form.pdf	Form
Customer Complaint Form English Form.pdf	Form
Customer Complaint Form English Form.pdf	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
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	Spanish Form.pdf	Yes	Yes	Fillable Fileable Signable
Form	N/A	Customer Complaint Form	English 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 %

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)	3,300	3,300
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.