Consumer Response Intake Form

ICR 202204-3170-002

OMB: 3170-0011

Federal Form Document

Forms and Documents
Document
Name
Status
Justification for No Material/Nonsubstantive Change
2022-04-13
Supporting Statement A
2017-11-28
IC Document Collections
IC ID
Document
Title
Status
198358 Unchanged
ICR Details
3170-0011 202204-3170-002
Received in OIRA 202112-3170-002
CFPB
Consumer Response Intake Form
No material or nonsubstantive change to a currently approved collection   No
Regular 04/13/2022
  Requested Previously Approved
10/31/2022 10/31/2022
3,000,000 3,000,000
387,500 387,500
0 0

The Intake Form is designed to aid consumers in the submission of complaints, inquiries, and feedback and to help the Consumer Financial Protection Bureau (CFPB) fulfill its statutory requirements. Consumers (also referred to as “respondents”) will be able to complete and submit information through the Intake Form electronically on the CFPB's website. Alternatively, respondents may request that the CFPB mail a paper copy of the Intake Form, and then mail or fax it back to the CFPB; or call to submit a complaint by telephone. The questions within the Intake Form prompt respondents for a description of, and key facts about, the complaint at issue, the desired resolution, contact and account information, information about the company they are submitting a complaint about, and previous action taken to attempt to resolve the complaint.

PL: Pub.L. 111 - 203 1021(c)(2); 1022(c); 1013(b)(3 Name of Law: Dodd–Frank Wall Street Reform and Consumer Protection Act
  
None

Not associated with rulemaking

  82 FR 33070 07/19/2017
82 FR 56223 11/28/2017
No

1
IC Title Form No. Form Name
Consumer Response Intake Forms

  Total Request 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 3,000,000 3,000,000 0 0 0 0
Annual Time Burden (Hours) 387,500 387,500 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$13,272,980
No
    Yes
    Yes
No
Yes
No
No
Tim Jakubowski 202 435-9620

  No

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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
04/13/2022


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