OMB control number

Consumer Response Intake Form

OMB 3170-0011 · CFPB.

OMB 3170-0011

The Intake Form is designed to aid the public in the submission of complaints, inquiries, and feedback to the CFPB and to help the CFPB fulfill the aforementioned statutory requirements. Consumers who wish to submit complaints, inquiries, and feedback may submit relevant information using the CFPB’s website where they will find an online version of the Intake Form. Alternatively, they may submit information by telephone and mail using the Intake Form. The Intake Form’s various fields prompt respondents for a description of, and key facts about, their complaints, underlying products and issues, the companies that are the subject of their complaints, and any previous action taken on their complaints. Responses to the Intake Form’s questions help provide the CFPB and the company with the information needed to contact the consumer and/or the consumer’s authorized representative (if applicable), send the complaint to the company for response, and follow-up on the submitted complaint, inquiry, or feedback.

The latest form for Consumer Response Intake Form expires 2029-03-31 and is listed under ICR 202511-3170-001.

All Historical Document Collections

Historical document collections
ReferenceFilingReceivedConcludedAction
202511-3170-001 Revision of a currently approved collection 2026-02-17 Approved without change
202304-3170-001 No material or nonsubstantive change to a currently approved collection 2023-04-20 Approved without change
202205-3170-001 Revision of a currently approved collection 2022-10-05 Approved with change
202204-3170-002 No material or nonsubstantive change to a currently approved collection 2022-04-13 Approved without change
202112-3170-002 No material or nonsubstantive change to a currently approved collection 2021-12-13 Approved without change
202108-3170-003 No material or nonsubstantive change to a currently approved collection 2021-08-27 Approved without change
202012-3170-001 No material or nonsubstantive change to a currently approved collection 2021-03-19 Approved without change
201711-3170-003 Revision of a currently approved collection 2017-11-28 Approved without change
201504-3170-001 Revision of a currently approved collection 2015-04-08 Approved without change
201407-3170-002 No material or nonsubstantive change to a currently approved collection 2014-07-08 Approved without change
201312-3170-002 No material or nonsubstantive change to a currently approved collection 2013-12-11 Approved without change
201311-3170-001 No material or nonsubstantive change to a currently approved collection 2013-11-01 Approved without change
201310-3170-001 No material or nonsubstantive change to a currently approved collection 2013-10-23 Approved without change
201307-3170-001 No material or nonsubstantive change to a currently approved collection 2013-07-01 Approved without change
201302-3170-003 No material or nonsubstantive change to a currently approved collection 2013-02-21 Approved without change
201205-3170-004 No material or nonsubstantive change to a currently approved collection 2012-06-11 Approved without change
201202-3170-001 No material or nonsubstantive change to a currently approved collection 2012-02-24 Approved without change
201111-3170-004 New collection (Request for a new OMB Control Number) 2011-11-21 Approved with change