Application Forms for Financial Empowerment Training Programs

Forms and Documents

Document Name	Status
3170-0068 SSA - Application Forms for Finanical Empowerment Programs OMB.docx Supporting Statement A	2020-01-30

IC Document Collections

IC ID	Document Title	Status
222949	Application Forms Other-Application	Modified

ICR Details

OMB Control No: 3170-0068	ICR Reference No: 202001-3170-001
Status: Active	Previous ICR Reference No: 201608-3170-002
Agency/Subagency: CFPB	Agency Tracking No:
Title: Application Forms for Financial Empowerment Training Programs
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 04/17/2020
	Date Received in OIRA: 02/10/2020
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2023	36 Months From Approved	04/30/2020
Responses	275	0	325
Time Burden (Hours)	825	0	1,625
Cost Burden (Dollars)	0	0	0

---

Abstract: The Consumer Financial Protection Bureau (CFPB or Bureau) is responsible for developing strategies to improve the financial capability of low-income and economically vulnerable consumers, such as consumers who are unbanked or underbanked, those with thin or no credit file, and households with limited savings. To address the needs of these consumers, the Bureau has developed two initiatives that target intermediary organizations and provide tools, training, technical assistance, and other services to help them reach low-income and economically vulnerable consumers to provide them the financial empowerment tools and information that they need, when they need it, where they are. These initiatives: (1) Your Money, Your Goals, , and (2) Tax Time Savings both require CFPB to engage organizations to participate in our financial empowerment initiatives (“Empowerment”). The proposed information collection request consists of application forms that will be used by community-based organizations, local, state, or federal government entities, and national non-profit organizations to indicate their desire and ability to participate in the Bureau’s various initiatives. Empowerment will use the information provided in these applications to select the best qualified organizations for participation.

---

Authorizing Statute(s): PL: Pub.L. 111 - 203 1013(b)(2) Name of Law: Dodd-Frank Wall Street Reform and Consumer Protection Act
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 62514	11/15/2019
30-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 7537	02/10/2020
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Application Forms

---

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	275	325	0	-50	0	0
Annual Time Burden (Hours)	825	1,625	0	-250	-550	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Changing Forms

Short Statement: The decrease in respondent and burden hours is due to the fact that a previously approved form, the financial coaching application, is no longer needed and its use under this information collection is discontinued, as well as Bureau efforts to assist respondents and train them in how to respond to this information collection which has reduced the burden of completing the remaining applications which has resulted in an estimated reductions of 2 hours per response, an estimated total adjustment of -550 hours.

---

Annual Cost to Federal Government:

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Yes

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

---

Common Form ICR:  No

---

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) 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.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 02/10/2020

---