Survey Screening Questions

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
3170-00XX Screener Survey Collection Supporting Statement_.docx	Supporting Statement A	Uploaded 2024-12-09	Repair queued
3170-00XX Screener Survey Collection Supporting Statement_.docx	Supporting Statement A	Uploaded 2024-12-09	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
272869	Screener Survey Questions	Other-Question Bank for Screeners	New

ICR Details

OMB Control No: 3170-0084	ICR Reference No: 202412-3170-002
Status: Active	Previous ICR Reference No:
Agency/Subagency: CFPB	Agency Tracking No:
Title: Survey Screening Questions
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 09/15/2025
Retrieve Notice of Action (NOA)	Date Received in OIRA: 12/09/2024
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2026	36 Months From Approved
Responses	50,000	0	0
Time Burden (Hours)	12,500	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: Conducting research, focus groups and Bureau service delivery requires that the bureau recruit average consumers to participate in focus groups, surveys and in-person testing. In order to make sure the persons recruited for such tasks represent a diverse cross-section of the people likely to use such services or have backgrounds that include experiences that make their feedback especially relevant to the research to be conducted or product to be tested, it is necessary to ask structured questions of potential participants to screen them and selected the most suitable to a particular task. This collection is a master list of demographic and experiential questions that will be used to assemble the screeners to be used for these projects,

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Authorizing Statute(s): PL: Pub.L. 111 - 203 1021 Name of Law: Dodd-Frank Wall Street Reform and Consumer Protection Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	89 FR 80231	10/02/2024
30-day Notice:	Federal Register Citation:	Citation Date:
	89 FR 96235	12/04/2024
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
Screener Survey Questions

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	50,000	0	0	50,000	0	0
Annual Time Burden (Hours)	12,500	0	0	12,500	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: This is a new collection that centralizes the burden previously borne in individualized information collections cleared under various generic and regular clearances where screening participants is necessary

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Annual Cost to Federal Government:

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Yes

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 12/09/2024

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