Collect Registration Form

 Collect Registration Form
The Bureau of Consumer Financial Protection’s Collect website allows financial institutions to respond
to the semi-annual Terms of Credit Card Plans (TCCP) Survey; to submit college credit card marketing
agreements and data; and to submit, amend, and withdraw credit card and prepaid account agreements
and related information. Please complete and submit this form to the Collect Support Team to establish a
point of contact (POC) for your company. The POC will then be able to submit TCCP Surveys, college credit
card marketing agreements, credit card agreements, prepaid account agreements, and any other required
information to the Bureau and create additional profiles for other employees of your financial institution
to submit surveys, agreements, and any other required information. For questions concerning this form,
please contact the Collect Support Team at Collect_Support@cfpb.gov.

Company information
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2

Please provide your
company’s name
and headquarters
location.

COMPANY NAME

Please provide
your company’s
identification
numbers. You must
provide at least one.

LEI

CITY (HEADQUARTERS)

RSSD ID

STATE

TAX ID (TIN)

Contact information
3

4

Please provide the
name and contact
information for the
individual who will
be your financial
institution’s POC.

Please select one
or more Collect
products for which
you are registering
as the POC.

FIRST NAME

LAST NAME

POSITION TITLE

WORK EMAIL ADDRESS

WORK PHONE

ALTERNATE WORK PHONE (OPTIONAL)

Terms of Credit Card Plans Survey

Quarterly Credit Card Agreements

Annual College Credit Card
Marketing Agreements and Data

Prepaid Account Agreements

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Submission instructions
To submit this form, please email it to Collect_Support@cfpb.gov.

Privacy Act Statement
The information you provide will permit the Bureau to process your request or inquiry so you may access
a system or interact with a Bureau information technology system. Information about your request
or inquiry (including your personally identifiable information) may be shared pursuant to the CFPB’s
published Privacy Act system of records notice CFPB.014 Direct Registration and User Management
System. This collection of information is authorized by 12 U.S.C. § 5492. Failure to provide the requested
information may prevent the Bureau from granting you direct access to this system.

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 OMB control number.
The OMB control numbers for the affected information collections are:
§ 3170-0001 (expiration date: 8/31/2022)
§ 3170-0014 (expiration date: 3/31/2022)
§ 3170-0015 (expiration date: 3/31/2023)
§ 3170-0050 (expiration date: 03/31/2022)
§ 3170-0052 (expiration date: 10/31/2021)
The time required to complete this information collection is estimated to average 10 minutes per survey
response for the TCCP Survey, 55 minutes per submission for the annual college credit card marketing
agreement and data submission, 10 minutes per submission for the quarterly credit card agreement
submission, and 5 minutes per submission for the prepaid account agreement submission. The obligation
to respond to this collection of information is mandatory. 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 at
the Bureau of Consumer Financial Protection (Attention: PRA Office), 1700 G Street NW, Washington, DC
20552, or by email to PRA_comments@cfpb.gov.

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