Consumer Response Intake Forms

Consumer Response Intake Form

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3170-0011 can be found here:

Documents and Forms

Document Name Document Type
Attachment 1.Inventory of Questions for the CFPB's CR Intake Form_FINAL.pdf Other-Inventory of Questions
Attachment 1.Inventory of Questions for the CFPB's CR Intake Form_FINAL.pdf Other-Inventory of Questions
Attachment 2.Consumer Response Intake Instruments_FINAL.pdf Other-Intake Instruments
Attachment 2.Consumer Response Intake Instruments_FINAL.pdf Other-Intake Instruments
Attachment 3.Net New Complaint Form Fields and Values_FINAL.xlsx Other-Fields and Values
Attachment 3.Net New Complaint Form Fields and Values_FINAL.xlsx Other-Fields and Values
Attachment 4.New Household and Income Questions_FINAL.pdf Other-Household and Income Questions
Attachment 4.New Household and Income Questions_FINAL.pdf Other-Household and Income Questions

Information Collection (IC) Details

IC Title:	Consumer Response Intake Forms	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Inventory of Questions	Attachment 1.Inventory of Questions for the CFPB's CR Intake Form_FINAL.pdf	Yes	Yes	Fillable Fileable
Other-Intake Instruments	Attachment 2.Consumer Response Intake Instruments_FINAL.pdf	Yes	Yes	Fillable Fileable
Other-Fields and Values	Attachment 3.Net New Complaint Form Fields and Values_FINAL.xlsx	Yes	Yes	Fillable Fileable
Other-Household and Income Questions	Attachment 4.New Household and Income Questions_FINAL.pdf	Yes	Yes	Fillable Fileable

Line of Business: Economic Development

Subfunction: Financial Sector Oversight

Privacy Act System of Records
Title: CFPB.005—Consumer Response System	FR Citation: 79 FR 21440

Number of Respondents: 3,000,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 75 %

	Approved	Previously Approved
Annual Number of Responses for this IC	3,000,000	3,000,000
Annual IC Time Burden (Hours)	387,500	387,500
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.