Consumer Response Company Boarding Form

BOARDING FORM

 CFPB Company Portal

OMB No. 3170-0054
Expiration Date: XX/XX/XX

To enable your company to review and respond to consumer complaints sent to your
company by the Consumer Financial Protection Bureau (CFPB), complete this form.
The information requested will allow us to provide access to the secure, web-based
portal for company-authorized individuals. Once you have completed the form you
may submit the form by email to [email protected].
Notice of Collection under the Privacy Act of 1974, 5 U.S.C. 552a(e)(3) (Privacy Act Statement)

The information that you provide to the Consumer Financial Protection Bureau (CFPB) will be used to create
a user account and provide access to the web-based Company Portal. Account access to the web-based
Company Portal will enable you to view complaints or inquiries filed against your company with the CFPB and
allow you to respond to the complaints or inquiries. The information you provide in the portal and boarding
form (including personally identifiable information (PII)) may be shared:
§ with parties to a complaint;
§ with third parties as necessary to get information relevant to responding to a complaint;
§ with a court, magistrate, or administrative tribunal in the course of a proceeding;
§ for enforcement, statutory, and regulatory purposes;
§ with another federal or state agency or regulatory authority; and
§ with a member of Congress; to the Department of Justice, a court, an adjudicative body or administrative
tribunal, or a party in litigation.
We may also share the response you submit regarding your company and its business activities (but not PII)
with the public through the public Consumer Complaint Database.
Although the Bureau does not otherwise anticipate further disclosing the information provided, it may also be
disclosed as indicated in the Routine Uses described in the System of Records Notice CFPB.005 – Consumer
Response System.
The collection of information is authorized by Pub. L. No. 111-203, Title X, Sections 1011, 1012, 1013(b)(3),
1021, 1034, codified at 12 U.S.C. 5491, 5492, 5493(b)(3), 5511, 5534.
You are not required to provide any PII; however, if you do not include the requested information you may not
be granted access to the Company Portal.

Consumer Financial
Protection Bureau

1 of 8

COMPANY BOARDING FORM

Paperwork Reduction Act Statement
According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and not
withstanding any other provision of law 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 3170-0054. It expires on XX/
XX/XXXX. The time required to complete this information collection is estimated to average approximately 10
minutes per response. The obligation to respond 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 the Consumer Financial Protection Bureau (Attention: PRA Office), 1700 G Street NW, Washington,
DC 20552, or by email to [email protected].

Consumer Financial
Protection Bureau

2 of 8

COMPANY BOARDING FORM

Company information
This section is required. Please fill out the information in this section as it relates to your company.

1
2
3
4
5

FULL NAME OF COMPANY

Indicate the
business structure
of your company

S Corporation

Limited Liability Company

Sole Proprietorship

Enter your
company’s tax ID

COMPANY’S TAX ID

Please list your
company’s URL
(website address)

COMPANY’S WEBSITE OR URL

Please list the
mailing address
of your company’s
headquarters

STREET

This should NOT be
a P.O. Box

6

Corporation

CITY

Does this address also reflect your state of incorporation or home state
of business?

Partnership

STATE

ZIP CODE

YES

NO

(If “Yes,” skip to question 8)

Answer questions 7 only if you answered “NO” to question 6

7

Please select the state of incorporation or home state of business
for your company

Consumer Financial
Protection Bureau

Select a state
Nevada
Nebraska
Montana
Missouri
Mississippi
Minnesota
Michigan
Massachusetts
Maryland
Maine
Louisiana
Kentucky
Kansas
Iowa
Indiana
Illinois
Idaho
Hawaii
Georgia
Florida
Delaware
Connecticut
Colorado
California
Arkansas
Arizona
Alaska
Alabama
New
North
Rhode
Pennsylvania
Oregon
Oklahoma
Ohio
South
West
Washington
Virginia
Vermont
Utah
Texas
Tennessee
Wyoming
Wisconsin
Hampshire
Jersey
Mexico
York
Virginia
Carolina
Dakota
Carolina
Dakota
Island

3 of 8

COMPANY BOARDING FORM

Company information (continued)

8

Is your company or a portion of your company owned by another company,
often referred to as a parent company?

YES

NO

Answer questions 9-13 only if you answered “YES” to question 8

9

Please enter the
full name of your
parent company

PARENT COMPANY’S FULL NAME

10

Please list a point
of contact (POC)
for your parent
company

FULL NAME OF POINT OF CONTACT FOR PARENT COMPANY

11

Please list a contact
phone number or
email address for
the POC

WORK PHONE

Please list the
parent company’s
mailing address

STREET

12

CITY

13

Enter your parent
company’s tax ID

POSITION TITLE

EMAIL

STATE

ZIP CODE

PARENT COMPANY’S TAX ID

Consumer Financial
Protection Bureau

4 of 8

COMPANY BOARDING FORM

Contact information
The authorized company officer or their designee will be the main points of contact (POC) for the
Company Portal and will be registered with administrative access to add and manage access for
additional company personnel as desired. The Company Portal Manual provides details about
managing portal access for company users.

14

15

Please provide the
information of the
authorized officer/
employee

If the authorized
officer/employee
is unavailable,
please list the
full name of the
official designee

AUTHORIZED OFFICER/EMPLOYEE FULL NAME

POSITION/TITLE

EMAIL

WORK PHONE

OFFICIAL DESIGNEE FULL NAME

EMAIL

POSITION/TITLE

WORK PHONE

Affiliates and subsidiaries information
The following information is needed to facilitate timely routing of consumer complaints about any
company affiliates and subsidiaries.

16

Does your company have any affiliates or subsidiaries?
(If “YES,” please fill out the following section for each affiliate or subsidiary)

Consumer Financial
Protection Bureau

YES

NO

5 of 8

COMPANY BOARDING FORM

17

Answer these questions only if you have answered “Yes” to question 16
(Please only list subsidiaries and affiliates that provide consumer financial products or services,
and whose businesses would impact CFPB’s routing of consumer complaints)
AFFILIATE/SUBSIDIARY FULL NAME

TAX ID

STREET

STATE

CITY

AFFILIATE/SUBSIDIARY FULL NAME

ZIP CODE

TAX ID

STREET

CITY

STATE

AFFILIATE/SUBSIDIARY FULL NAME

ZIP CODE

TAX ID

STREET

CITY

STATE

Consumer Financial
Protection Bureau

ZIP CODE

6 of 8

COMPANY BOARDING FORM

Affiliates and subsidiaries information (continued)
AFFILIATE/SUBSIDIARY FULL NAME

TAX ID

STREET

CITY

STATE

ZIP CODE

Products / service information
The following information is needed to facilitate timely routing of consumer complaints about any
company affiliates and subsidiaries.

18

What are your
company’s primary
consumer financial
product/service
offerings?

Debt collection

(select all that
apply)

Checking or savings
account

Credit card or prepaid card
Mortgage

Vehicle loan or lease

Money transfer, virtual currency, or money
service (check cashing service, currency
exchange, cashier’s/traveler’s check)
Payday loan, title loan, or personal loan
(installment loan or personal line of credit)
Credit reporting, credit repair services, or
other personal consumer reports
Other

Student loan
PLEASE PROVIDE ADDITIONAL INFORMATION IF YOU SELECTED “OTHER”

Consumer Financial
Protection Bureau

7 of 8

COMPANY BOARDING FORM

Submit

19

By clicking this box, I am indicating that the information given is true to the best of my
knowledge and belief.
DATE

COMPANY NAME

FULL NAME

POSITION/TITLE

EMAIL

WORK PHONE

To submit, save this completed form and email to [email protected].
If the information you provided changes, please email [email protected].

Consumer Financial
Protection Bureau

8 of 8
4/2022