Consumer Response Intake Form

The Intake Form is designed to aid consumers in the submission of complaints, inquiries, and feedback and to help the Consumer Financial Protection Bureau (CFPB) fulfill its statutory requirements. Consumers (also referred to as “respondents”) will be able to complete and submit information through the Intake Form electronically on the CFPB's website. Alternatively, respondents may request that the CFPB mail a paper copy of the Intake Form, and then mail or fax it back to the CFPB; or call to submit a complaint by telephone. The questions within the Intake Form prompt respondents for a description of, and key facts about, the complaint at issue, the desired resolution, contact and account information, information about the company they are submitting a complaint about, and previous action taken to attempt to resolve the complaint.

The latest form for Consumer Response Intake Form expires 2022-10-31 and can be found here.