Information Collection

Application To Serve as a Small Entity Representative

IC 257656 under ICR 202212-3170-005 · OMB 3170-0037.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Application To Serve as a Small Entity Representative	Form
Application to Serve as a Small Entity Representative Application to Serve as a Small Entity Representative.pdf	Form
Application to Serve as a Small Entity Representative Application to Serve as a Small Entity Representative.pdf	Form

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

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
Form	N/A	Application to Serve as a Small Entity Representative	Application to Serve as a Small Entity Representative.pdf		Yes	Yes	Fillable Fileable

Line of Business: Economic Development

Subfunction: Financial Sector Oversight

Privacy Act System of Records

Title: CFPB.016: CFPB Advisory Boards and Committees

FR Citation: 83 FR 23435

Number of Respondents: 10

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	10	10
Annual IC Time Burden (Hours)	2	2
Annual IC Cost Burden (Dollars)	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.