Consumer Response Intake Form

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Document Name Document Type
3170-0011 Intake Instruments and Product Subproduct Issue and Subissue Values.docx Other-collection instruments
3170-0011 Intake Instruments and Product Subproduct Issue and Subissue Values.docx Other-collection instruments
3170-0011 Inventory of Questions.docx Other-inventory of questions
3170-0011 Inventory of Questions.docx Other-inventory of questions

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Consumer Response Intake 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	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-collection instruments			3170-0011 Intake Instruments and Product Subproduct Issue and Subissue Values.docx		Yes	Yes	Fillable Fileable
Other-inventory of questions			3170-0011 Inventory of Questions.docx		Yes	Yes	Fillable Fileable

Line of Business: Economic Development

Subfunction: Financial Sector Oversight

Privacy Act System of Records
Title: CFPB.005—Consumer Response System	FR Citation: 79 FR 21440

Number of Respondents: 2,150,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 75 %

	Approved	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	2,150,000	0	-850,000	3,000,000
Annual IC Time Burden (Hours)	415,000	27,500	0	387,500
Annual IC Cost Burden (Dollars)	0	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.