IC Template for CFPB Tax Time Savings Campaign

Request for Approval under the “GENERIC CLEARANCE FOR QUALITATIVE
CONSUMER EDUCATION, ENGAGEMENT, AND EXPERIENCE INFORMATION
COLLECTIONS”

(OMB Control Number: 3170-0036)
1. TITLE OF INFORMATION COLLECTION:
CFPB Ready, Set, Save Tax Time Savings Campaign

2. PURPOSE:
The purpose of this inquiry is to collect baseline and logistical information from non-profit
organizations that will partner with the CFPB on our 2014 campaign, called Ready, Set, Save,
to encourage Earned Income Tax Credit -recipient taxpayers to engage in savings and wealthbuilding during the tax preparation process. CFPB will use the information to assess the
organizations’ programs and needs in order to coordinate training and distribution of CFPB
informational materials to the non-profits in a timely and effective manner. This information
will not be used to evaluate the quality or effectiveness of the individual programs or
respondents.

3. DESCRIPTION OF RESPONDENTS:
Respondents to this inquiry will be lead staff of approximately 18 non-profit and community
based organizations participating in the Ready, Set, Save pilot.
4. TYPE OF COLLECTION (ADMINISTRATION OF THE INSTRUMENT):
a.

How will you collect the information? (Check all that apply)
[X] Web-based or other forms of Social Media
[ ] In-person
[ ] Small Discussion Group
[ ] Other, Explain ______________________

[ ] Telephone
[ ] Mail
[ ] Focus Group

b. Will interviewers or facilitators be used?
[ ] Yes [ X] No [ ] Not Applicable
5. FOCUS GROUP OR SURVEY:
If you plan to conduct a focus group or survey, please provide answers to the following
questions:

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a. Do you have a customer list or something similar that defines the universe of potential
respondents and do you have a sampling plan for selecting from this universe?
[ X] Yes [ ] No [ ] Not Applicable
b. If the answer is yes, please provide a description below. If the answer is no, please
provide a description of how you plan to identify your potential group of respondents and
how you will select them?
The respondents will be the lead staff of organizations that the CFPB has selected to be
partners in the 2014 Ready, Set, Save tax time savings campaign.

6. INFORMATION COLLECTION PROCEDURES
Respondents will receive the survey via email and will be asked to complete and return
the survey.
7. PERSONALLY IDENTIFIABLE INFORMATION:
a. Is personally identifiable information (PII) collected? [ ] Yes [ X] No
b. If Yes, is the information that will be collected included in records that are subject
to the Privacy Act of 1974? [ ] Yes [ ] No [ X ] Not Applicable
c. If Applicable, has a System or Records Notice been published?
[ ] Yes [ ] No [ X ] Not Applicable

8. INCENTIVES:
a. Is an incentive provided to participants? [ ] Yes [ X ] No
b. If Yes, provide the amount or value of the incentive? $____N/A_______.
c. If Yes, provide a statement justifying the use and amount of the incentive.
N/A

9. ASSURANCES OF CONFIDENTIALITY:
a. Will a pledge of confidentiality be made to respondents? [ ] Yes [ X] No
b. If Yes, please cite the statue, regulation, or contractual terms supporting the pledge.

10. JUSTIFICATION OF SENSITIVE QUESTIONS (if applicable):
N/A

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11. BURDEN HOURS:
Category of Respondent

Number of Participation
Respondents
Time
18
10 minutes

[Insert rows as needed]
Totals

18

10 minutes

Burden
3 hours
3 hours

12. FEDERAL COST: The estimated annual cost to the Federal government is $____0____.

13. CERTIFICATION:
By submitting this document, the Bureau certifies the following to be true:
 The collection is voluntary.
 The collection is low-burden for respondents.
 The collection is non-controversial and does not raise issues of concern to other federal
agencies.
 Information gathered will not be used for the purpose of substantially informing influential
policy decisions.
 The results will not be used to measure regulatory compliance or for program evaluation.

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