CFPB v Timemark Claim Worksheet

Generic Information Collection Plan for the Collection of Qualitative Feedback on Bureau Service Delivery

CFPB v Timemark Claim Worksheet

OMB: 3170-0024

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Shape1 Shape2 CFPB v. Timemark Claims Administrator P.O. Box 5447

Portland, OR 97228-5447



<<Mail ID>>

<<Name 1>>

<<Name 2>>

<<Address 1>>

<<Address 2>>

<<Address 3>>

<<Address 4>>

<<Address 5>>

<<City>><<State>><<Zip>>

<<Country>>



TrackingNumber: <Tracking Number>>

Shape8 <<DATE>>


To receive a payment, you must submit a claim by

<<Claims Due Date>>.



Shape9 CLAIM WORKSHEET

Consumer Financial Protection Bureau v. Timemark Solutions, Inc.

Shape10 Case No. 9:20-cv-81057


We are the Consumer Financial Protection Bureau (CFPB), a federal government agency that enforces laws that protect consumers. The CFPB sued Timemark Solutions, Inc. and its owners and officers for charging illegal advance fees for student loan debt relief services and not describing their services accurately. The CFPB prevailed in its lawsuit, and the company’s records indicate that Timemark Solutions, Inc. collected fees from you in violation of the law.


If you believe you paid fees to Timemark Solutions, Inc., you may be eligible for a refund. If you have already received a check, and if any of the fees you paid to Timemark Solutions, Inc. were not included in the check you received, you may claim the additional fees you paid.


Here’s how:

  1. Gather all the information about fees you paid to Timemark Solutions, Inc., including amount, date of payment, and description of fee, if known, along with proof of all your payments, such as credit card or bank statements or copies of canceled checks;

  2. Use the attached optional worksheet to organize each claim; and

  3. Sign, date, and return this form, either by emailing it to [email protected] or mailing it to P.O. Box 5447, Portland, OR 97228-5447. You may also visit CFPB-Timemark.org to file a claim online.

Shape11

COMPLETE THIS SECTION ONLY IF YOUR NAME AND ADDRESS PRINTED ABOVE NEED TO BE CORRECTED.

First Name* MI* Last Name* Business Name (if applicable)

*Please provide copies of supporting documentation for any name changes.

Mailing Address



City State ZIP Code

Shape12

required


These are questions to consider before submitting your claim.


> Have you already received a refund for any of the fees you paid to Timemark Solutions, Inc. listed on this claim form?


> Why are we asking this question?

If you already received a fee refund from Timemark Solutions, Inc. or any other source, you are not eligible for another refund of the same fee. Please only list fees for which you have not received a refund.


Shape13 Shape14 Yes No


> Did you include proof of payment for all fees you paid to Timemark Solutions, Inc.?


> Why are we asking this question?

Fees for which you do not have a receipt or other proof of payment may not be eligible for a refund.


Shape15 Shape16 Yes No



Please fill in the total dollar amount of the fees you paid and sign below. Attach copies of all payments and receipts.



Shape17 Shape18


Shape19

The information I have provided on this form is true to the best of my knowledge.


Shape22 Shape23 Shape21 Shape20

Signature:



MM DD YY


This worksheet is intended to help organize your receipts.


HOW MUCH DID YOU PAY?


You need to send proof of the amount(s) of fees you paid to Timemark Solutions, Inc. so we can confirm your payments and process your refund claim. Make copies of the proofs of payment and any receipts. Here are some ways you can provide proof of payment:


Canceled check image(s).

Canceled money order image(s).

eCheck receipt(s).

Credit card, debit card, or bank statement showing payment was sent to Timemark Solutions, Inc..

Email confirmation from Timemark Solutions, Inc. or someone acting on its behalf that a specific payment was received.


Shape33 How much did you pay Timemark Solutions, Inc. from January 2016 through October 2019? Fill out one section for each payment you made.


Shape34 Shape35 Shape36 Shape37 Shape38 Shape39 Date of Payment (MM/DD/YY) Amount Payment made to:

/ /

Is proof of payment attached? Proof of payment is required for eligibility.

Shape40 Shape41 YES NO


Was this fee refunded already?

Shape42 Shape43 Shape44 YES NO



Shape45 Shape46 Shape47 Shape48 Shape49 Shape50 Date of Payment (MM/DD/YY) Amount Payment made to:

/ /

Is proof of payment attached? Proof of payment is required for eligibility.

Shape51 Shape52 YES NO


Was this fee refunded already?

Shape53 Shape54 Shape55 YES NO



Shape56 Shape57 Shape58 Shape59 Shape60 Shape61 Date of Payment (MM/DD/YY) Amount Payment made to:

/ /

Is proof of payment attached? Proof of payment is required for eligibility.

Shape62 Shape63 YES NO


Was this fee refunded already?

Shape64 Shape65 Shape66 YES NO



Shape67 Shape68 Shape69 Shape70 Shape71 Shape72 Date of Payment (MM/DD/YY) Amount Payment made to:

/ /

Is proof of payment attached? Proof of payment is required for eligibility.

Shape73 Shape74 YES NO


Was this fee refunded already?

Shape75 Shape76 YES NO

This worksheet is intended to help organize your receipts.


HOW MUCH DID YOU PAY?

You need to send proof of the amount(s) of fees you paid to Timemark Solutions, Inc. so we can confirm your payments and process your refund claim. Make copies of the proofs of payment and any receipts. Here are some ways you can provide proof of payment:


Canceled check image(s).

Canceled money order image(s).

eCheck receipt(s).

Credit card, debit card, or bank statement showing payment was sent to Timemark Solutions, Inc..

Email confirmation from Timemark Solutions, Inc. or someone acting on its behalf that a specific payment was received.


Shape82 How much did you pay Timemark Solutions, Inc. from January 2016 through October 2019? Fill out one section for each payment you made.


Shape83 Shape84 Shape85 Shape86 Shape87 Shape88 Date of Payment (MM/DD/YY) Amount Payment made to:

/ /

Is proof of payment attached? Proof of payment is required for eligibility.

Shape89 Shape90 YES NO


Was this fee refunded already?

Shape91 Shape92 Shape93 YES NO



Shape94 Shape95 Shape96 Shape97 Shape98 Shape99 Date of Payment (MM/DD/YY) Amount Payment made to:

/ /

Is proof of payment attached? Proof of payment is required for eligibility.

Shape100 Shape101 YES NO


Was this fee refunded already?

Shape102 Shape103 Shape104 YES NO



Shape105 Shape106 Shape107 Shape108 Shape109 Shape110 Date of Payment (MM/DD/YY) Amount Payment made to:

/ /

Is proof of payment attached? Proof of payment is required for eligibility.

Shape111 Shape112 YES NO


Was this fee refunded already?

Shape113 Shape114 Shape115 YES NO



Shape116 Shape117 Shape118 Shape119 Shape120 Shape121 Date of Payment (MM/DD/YY) Amount Payment made to:

/ /

Is proof of payment attached? Proof of payment is required for eligibility.

Shape122 Shape123 YES NO


Was this fee refunded already?

Shape124 Shape125 YES NO

Frequently Asked Questions and Privacy Act Notice

Please keep for your records.


Why did you send me a claim worksheet?

We sent you a claim worksheet because we obtained information indicating that you may have been a client of Timemark Solutions, Inc. or because you requested a claim worksheet. We’re providing an opportunity for you to send us more information about payments you made to Timemark Solutions, Inc. that may be eligible for a refund. We will review all receipts to determine eligibility for refunds.


Why do I need to provide the requested information?

Your name, contact information, and payment information are used to verify that you are eligible for refunds of payments you made. Please submit your receipts by the deadline printed at the top of the claim worksheet. Please note that all information submitted is treated in accordance with the Privacy Act, described below.


What is my claim amount?

Your claim amount is the total amount of money you paid to Timemark Solutions, Inc., Inc. in up-front fees.


Who is Epiq?

The CFPB has contracted with Epiq to administer claims and payments to consumers on our behalf.


How do I verify that this claims process is legitimate?

The CFPB never requires you to pay money up front or provide any banking information, credit card information, or other payment information before you can cash refund checks that the CFPB has issued. If anyone claims that they can get you a refund but asks you for money, it could be a scam. You can verify with the CFPB that this is a legitimate claims process by calling the CFPB directly at (855) 411-2372 or by visiting our website at CFPB-Timemark.org.


Can I still ask questions?

To find out more about the case or the payment, please contact the Claims Administrator:

Email: [email protected]

Call: (866) 991-0913

Write: P.O. Box 5447, Portland, OR 97228-5447

Visit: CFPB-Timemark.org


Notice of Privacy Act Statement:

The information we are requesting is being collected to determine your eligibility for a redress payment to compensate you for harm suffered from a violation of a Federal consumer financial law that was the subject of a Bureau enforcement action.


This information may be used by and disclosed to employees, contractors, agents, and others authorized by the CFPB to receive this information to assist in providing your redress. It may also be disclosed:

to a court, magistrate, or administrative tribunal in the course of a proceeding;

for enforcement, statutory, and regulatory purposes;

to another federal or state agency or regulatory authority;

to a member of Congress, to the Department of Justice, a court, an adjudicative body or administrative tribunal, or a party in litigation; and

pursuant to the CFPB’s published Privacy Act system of records notice, CFPB.025 – Civil Penalty Fund and Bureau-Administered Redress Program Records.


The collection of this information is authorized by Pub. L. 111-203, Title X, Sections 1017(d) (Civil Penalty Fund) and/or 1055(a) (Redress), codified at 12 U.S.C. §§ 5497(d), 5565(a). You are not required to submit or provide any identifying information; however, not doing so may delay processing or be a basis for rejection of your claim.


According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a valid OMB control number. The OMB control number for this collection is ____-____. It expires on __/__/202__. The time required to complete this information collection is estimated to average approximately 30 minutes per response. Responding to this collection of information is voluntary. Comments regarding this collection of information, including the estimated response time, suggestions for improving the usefulness of the information, or suggestions for reducing the burden to respond to this collection should be submitted to Bureau of Consumer Financial Protection (Attention: PRA Office), 1700 G Street NW, Washington, DC 20552, or by email to [email protected].

Shape4 Shape5 Shape6 Shape7 Shape3

Email [email protected] or call (866) 991-0913.

Questions?


File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorNoga, Sinead (CFPB)
File Modified0000-00-00
File Created2022-10-07

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