IC Template - Tax Time 2016 Pre-session Survey

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 Tax Time Savings Initiative; Pre-tax season pilot participant survey
2. PURPOSE:
The purpose CFPB Tax Time Savings Initiative is to encourage earned income tax credit
(EITC)-recipient taxpayers to engage in savings and wealth-building activities during the tax
preparation process. This is the first request for information from 25 organizations that agreed
to participate in the CFPB tax time savings pilot project. This inquiry is intended primarily to
collect logistical information from the organizations on best times for the CFPB to offer
training, quantities of various materials the organizations could use in their tax campaign and
the number of people participating in the trainings provided by the CFPB. From the results of
this initial inquiry we will be able to schedule and deliver 4 webinar style trainings for staff and
volunteers and deliver educational and consumer materials to the organizations participating in
the pilot project in advance of tax season. 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 the lead staff of 25 non-profit and community based
organizations participating in the Tax Time Savings pilot.
4. TYPE OF COLLECTION (ADMINISTRATION OF THE INSTRUMENT):
a.

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

[ ] 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:
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
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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?
Respondents to this inquiry will be the lead staff of 25 non-profit and community based
organizations participating in the Tax Time Savings pilot.
6. INFORMATION COLLECTION PROCEDURES
Please summarize the procedures that will be used to collect data from respondents.
Respondents will receive the request for information via email and will be asked to respond
via email.
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.
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
11. BURDEN HOURS:
Category of Respondent

Totals:

Number of
Respondents

Frequency

Number of
Responses

1x

25
25

25
25

Response
Time
(hours)
.17
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12. FEDERAL COST: The estimated annual cost to the Federal government is $_0__
2

Burden
(hours)
4
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13. CERTIFICATION:
CERTIFICATION PURSUANT TO 5 CFR 1320.9, AND THE RELATED PROVISIONS
OF 5 CFR 1320.8(b)(3) :
By submitting this document, the Bureau certifies the following to be true:
(a) It is necessary for the proper performance of agency functions;
(b) It avoids unnecessary duplication;
(c) It uses plain, coherent, and unambiguous terminology that is understandable to
respondents;
(d) Its implementation will be consistent and compatible with current reporting and
recordkeeping practices;
(e) It indicates the retention period for recordkeeping requirements;
(f) It informs respondents of the information called for under 5 CFR 1320.8(b)(3):
(i) Why the information is being collected;
(ii) Use of information;
(iii) Burden estimate;
(iv) Nature of response (voluntary);
(v) Nature and extent of confidentiality; and
(vi) Need to display currently valid OMB control number;
(g) It was developed by an office that has planned and allocated resources for the efficient
and effective management and use of the information to be collected;
(h) It uses effective and efficient statistical survey methodology; and
(i) It makes appropriate use of information technology.

CERTIFICATION FOR INFORMATION COLLECTIONS SUBMITTED UNDER A
GENERIC INFORMATION COLLECTION PLAN
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 collection is not statistically significant; the results are not intended to be generalizable
beyond the survey population.
 The results will not be used to measure regulatory compliance or for program evaluation.

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