Information Collection

Consumer Response Intake Form

IC 198358 under ICR 202205-3170-001 · OMB 3170-0011.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
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

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:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-collection instruments					Yes	Yes	Fillable Fileable
Other-inventory of questions					Yes	Yes	Fillable Fileable

Line of Business: Economic Development

Subfunction: Financial Sector Oversight

Privacy Act System of Records

Title: CFPB.005âConsumer 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 %

table that charts list of burden
	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

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.

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