Information Collection

Future Income Payments Claims Form

IC 277853 under ICR 202505-3170-001 · OMB 3170-0024.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Future Income Payments Processing Form Future Income Payments Claims Form	Form
Future Income Payments Processing Form Future Income Payments Processing Form.docx	Form
3170-0024 - Future Income Payments Claims Form (Supporting Statement).docx 3170-0024 - Future Income Payments Claims Form (Supporting Statement)	IC Document

IC Title:

Agency IC Tracking Number:

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				Yes	Yes	Fillable Printable

Line of Business: Economic Development

Subfunction: Financial Sector Oversight

Privacy Act System of Records

Title: CFPB.025 - Civil Penalty Fund and Bureau-Administered Redress Program Records

FR Citation: 83 FR 23435

Number of Respondents: 1,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,000	1,000
Annual IC Time Burden (Hours)	500	500
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
3170-0024 - Future Income Payments Claims Form (Supporting Statement)		10/09/2025

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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