3170-0036 - Family Engagement Screener PAS

Privacy Act Statement
5 U.S.C. 552a(e)(3)
The information you provide will be used to determine your eligibility to participate in a focus group
conducted by ICF International (ICF) and sponsored by the Consumer Financial Protection Bureau
(CFPB). The purpose of the focus group is to understand to what extent youth financial education
programs impact households.
This form may collect your age, gender, education, race, ethnicity, household characteristics, and
exposure to financial education. Your demographic information may be linked to other personally
identifiable information (PII) such as your full name and contact information for the purpose of
screening participants and scheduling a session. However, your last name and contact information will
not be provided to ICF or the CFPB.
Information collected will be treated in accordance with the System of Records Notice (SORN), CFPB.021
– CFPB Consumer Education and Engagement Records. Although the CFPB does not anticipate further
disclosing the information provided, it may be disclosed as indicated in the Routine Uses described in
the SORN. Direct identifying information will be kept private except as required by law.
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 is voluntary. However, if you choose not to provide the requested information, you may
not be eligible to participate in the focus group.