Information Collection

Customer Complaint Form

IC 269823 under ICR 202509-1557-002 · OMB 1557-0232.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Customer Complaint Form (English) Customer Complaint Form	Form
Customer Complaint Form (Spanish Revised) Customer Complaint Form	Form
CAMP Complaint Submission - CAMP Consumer Portal.pdf	Other-Consumer Portal
CAMP Complaint Submission - CAMP Consumer Portal.pdf	Other-Consumer Portal
Privacy Act Statement.docx	Other-Privacy Act Statement
Privacy Act Statement.docx	Other-Privacy Act Statement
Customer Complaint Form (English) customer-complaint-form-English.pdf	Form
Customer Complaint Form (English) customer-complaint-form-English.pdf	Form
Customer Complaint Form (Spanish Revised) PREVIEW_Complaint Form -Consumer Spanish Revised 9.2.25.pdf	Form
Customer Complaint Form (Spanish Revised) PREVIEW_Complaint Form -Consumer Spanish Revised 9.2.25.pdf	Form

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Consumer Portal		Yes	Yes	Fillable Fileable
Form	N/A	Yes	Yes	Fillable Fileable Signable
Other-Privacy Act Statement		Yes	No	Printable Only
Form	N/A	Yes	Yes	Fillable Fileable Signable

Line of Business: Economic Development

Subfunction: Financial Sector Oversight

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 10,000

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	Previously Approved
Annual Number of Responses for this IC	10,000	10,000
Annual IC Time Burden (Hours)	3,300	3,300
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.

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