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 can be found here.

Latest Forms, Documents, and Supporting Material
Document
Name
Public Comments
PC_202511-3170-001_030226_052544_1.pdf (document unavailable)
Public Comments
CFPB Complaint Portal RMAI Comment 2026 02 25.pdf (document unavailable)
Public Comments
PC_202511-3170-001_030226_034308_1.pdf (document unavailable)
Public Comments
Public Comments
Public Comments
NCLC Comment re changes to CFPB complaint intake form.pdf (document unavailable)
Public Comments
PC_202511-3170-001_030226_015057_1.pdf (document unavailable)
Public Comments
Auriemma Roundtables CFPB Intake Form Comment 2.27.26.pdf (document unavailable)
Public Comments
Supporting Statement A
CBA comment.pdf (document unavailable)
Public Comments
CDIA comment.pdf (document unavailable)
Public Comments
AFSA comment.pdf (document unavailable)
Public Comments
3170-0011 30-day FRN (published).pdf (document unavailable)
Supplementary Document
3170-0011 60-day FRN (published).pdf (document unavailable)
Supplementary Document
All Historical Document Collections
Approved without change
Revision of a currently approved collection 2026-02-17
Approved without change
No material or nonsubstantive change to a currently approved collection 2023-04-20
Approved with change
Revision of a currently approved collection 2022-10-05
Approved without change
No material or nonsubstantive change to a currently approved collection 2022-04-13
Approved without change
No material or nonsubstantive change to a currently approved collection 2021-12-13
Approved without change
No material or nonsubstantive change to a currently approved collection 2021-08-27
Approved without change
No material or nonsubstantive change to a currently approved collection 2021-03-19
Approved without change
Revision of a currently approved collection 2017-11-28
Approved without change
Revision of a currently approved collection 2015-04-08
Approved without change
No material or nonsubstantive change to a currently approved collection 2014-07-08
Approved without change
No material or nonsubstantive change to a currently approved collection 2013-12-11
Approved without change
No material or nonsubstantive change to a currently approved collection 2013-11-01
Approved without change
No material or nonsubstantive change to a currently approved collection 2013-10-23
Approved without change
No material or nonsubstantive change to a currently approved collection 2013-07-01
Approved without change
No material or nonsubstantive change to a currently approved collection 2013-02-21
Approved without change
No material or nonsubstantive change to a currently approved collection 2012-06-11
Approved without change
No material or nonsubstantive change to a currently approved collection 2012-02-24
Approved with change
New collection (Request for a new OMB Control Number) 2011-11-21