Consumer Compliant Monitoring System

Consumer Complaint Monitoring System

Documents and Forms

Document Name Document Type
eCCF screenshots document- English.docx Other-web form
eCCF screenshots document - Spanish v2.docx Other-web form - Spanish

Information Collection (IC) Details

IC Title:	Consumer Compliant Monitoring System	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-web form			eCCF screenshots document- English.docx		Yes	Yes	Fillable Fileable
Other-web form - Spanish			eCCF screenshots document - Spanish v2.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 3,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Previously Approved
Annual Number of Responses for this IC	3,000	3,000
Annual IC Time Burden (Hours)	750	750
Annual IC Cost Burden (Dollars)	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.