Consumer Financial Protection Bureau (CFPB) Tax Time Savings Initiative; Collection of Post-2017 Tax Season Data

OMB No. 3170-0036
Expiration Date: 8/31/2019

2017 Tax Time Savings Initiative Output
Data Collection Template
Thank you for your participation in the CFPB’s Tax Time Savings Initiative, and for agreeing
to provide this information about your program’s efforts to promote savings among the
taxpayers with whom you work. Through this data collection template, we are hoping to
collect information from your program about the number of tax returns filed through your sites,
as well as the number of taxpayers who participated in various savings-related activities.
While providing these data is strictly voluntary, the information you provide will be extremely
helpful to the Bureau in documenting the outcomes of your hard work.
Please note that the Bureau intends to keep your responses private to the extent permitted by
law, and when results are reported none of your answers will be connected to your
organization.
We estimate that this survey will take no more than 30 minutes to complete. We would
appreciate your reply by May 15, 2017”. If you have any questions, please contact [ICF survey
contact] at [phone number] or [email address].

Privacy Act Statement
5 U.S.C. 552(a)(e)(3)
The information you provide through your responses to the Consumer Financial Protection Bureau
(“CFPB”) will assist us in learning about your program’s efforts to promote savings among the taxpayers
with whom you work.
The CFPB will access basic contact information such as your name, address, phone number, email
address, or mailing address.
Information collected by the CFPB will be treated in accordance with the System of Records Notice
(“SORN”), CFPB.021 Consumer Education and Engagement Records, 79 FR 78839. This information will
not be disclosed as outlined in the Routine Uses for the SORN. Direct identifying information will only be
used by CFPB to facilitate the study and will be kept private except as required by law.
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This collection of information is authorized by Pub. L. No. 111-203, Title X, Sections 1013 and 1022,
codified at 12 U.S.C. §§ 5493 and 5512.
Participation in this study is voluntary, you are not required to participate or share any identifying
information with CFPB, and you may withdraw participation at any time.
Paperwork Reduction Act Statement
According to the Paperwork Reduction Act of 1995, “an agency may not conduct or sponsor, and a
person is not required to respond to, a collection of information unless it displays a valid Office of
Management and Budget (OMB) control number.” The OMB control number for this collection is
3170-0036 and expires 8/31/2019. The time required to complete this information collection is
estimated to average approximately 30 minutes per response. Comments regarding this
collection of information—including the estimated response time, suggestions for improving the
usefulness of the information, or suggestions for reducing the burden to respond to this
collection—should be submitted to the Consumer Financial Protection Bureau (Attention: PRA
Office), 1700 G Street NW, Washington, DC 20552, or by email to CFPB_PRA@cfpb.gov.

1. Did all of your sites participate in the CFPB Tax Time Savings Initiative? (Yes, all
of my tax sites participated in the CFPB Tax Time Savings Initiative/No, some of
my tax sites participated in the CFPB Tax Time Savings Initiative and others did
not)
If “Yes,” respondents will be asked Question 2 and then Questions 4 and 5.
If “No,” respondents will be asked Question 3 and then Questions 4 and 5.
2. Please complete the following table based on tax returns filed at your tax sites.
a) Number of tax returns prepared
b) Number of tax returns prepared
that claimed an Earned Income Tax
Credit (EITC)
c) Number of tax returns prepared
that claimed a refund
d) Number of tax returns prepared
that used direct deposit to receive
their refund
e) Number of tax returns prepared
that split their refund using IRS form
8888
f) Number of tax returns that
purchased a U.S. Series I savings
bond
g) Number of tax returns prepared that
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deposited a portion of their refund
into a myRA
3. Please complete the following table. The numbers in the first column should
reflect tax returns filed at all of your program’s tax sites, and the numbers in the
second column should reflect only tax returns filed at sites participating in the
CFPB Tax Time Savings Initiative.
All Tax Sites

Sites Participating in
CFPB Initiative

a) Number of tax returns prepared
b) Number of tax returns prepared
that claimed an Earned Income Tax
Credit (EITC)
c) Number of tax returns prepared
that claimed a refund
d) Number of tax returns prepared
that used direct deposit to receive
their refund
e) Number of tax returns prepared
that split their refund using IRS form
8888
f) Number of tax returns that
purchased a U.S. Series I savings
bond
g) Number of tax returns prepared that
deposited a portion of their refund
into a myRA
4. If you left any of the entries in the table blank, could you explain why?
5. Are there any other numerical measures that you use to measure how well tax
savings strategies have worked at your sites? If so, what are they, and what were
your results for the 2017 tax season?
Thank you!

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