OMB Control Number: 3170

- XXXX Expiration Date: XX/XX/XXXX

Page 1 Paperwork Reduction Act

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 number for this
collection is 3170

- XXXX . It expires on MM/DD/YYYY . The time required to complete this information collection is estimated to average approximately 10 minutes per response, including the time for reviewing any instr uctions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. The obligation to respond to this collection of information is voluntary. 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 Bureau at the Consumer Financial Protection Bureau (Attention: PRA Office), 1700 G Street NW, Washington, DC 20552, or by email to CFPB_Public_PRA@cfpb.gov.

The Bureau will not disclose any personally identifiable information collected except to the extent that it is required to do so by law and as prov ided in the Privacy Act Statement listed below. Additionally, the Bureau will treat the information collected consistent with its confidentiality regulations at 12 C.F.R. Part 1070, et seq. 

## Instrument s 4 and 5 : Three

- Month Case Manager Survey /

Six

- Month Case Manager Survey
Respondents: Case Managers
Collection Strategy: Paper Form

Follow

- Up Case Manager Survey

Thank you for completing this survey as part of our evaluation of trainings based on the FET Toolkit. Please note that your responses will be kept confidential, and when survey results are reported none of your answers will be connected to your organizatio n.

Your organization/agency: ______________________________________

1) Since being trained in the use of the Financial Empowerment Training Toolkit...

# of Clients

With how many clients have you discussed financial information?

With how many clients have you used tools and resources from the Financial Empowerment Training Toolkit? How many clients have you referred to other financial resources (such as credit counselors, free tax preparation, financial coaching, etc) ?

2) Do you think the Financial Empowerment Training Toolkit has affected your interactions with

clients ?

 Yes, it has affected them a lot
 Yes, it has affected them some
 Yes, it has affected them a little
 No, it has not affected my interactions with clients

2b) Please explain your answ er to this question.OMB Control Number: 3170

- XXXX Expiration Date: XX/XX/XXXX

Page 2 __________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

3) Have clients had any financial issues or made any requests related to financial topics that you have not known how to address? If so, please describe below.

________________ ___________________________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

4) How confident are yo u in your ability to...

Very
Confident Confident Somewhat
Confident Not at All
Confident
Understand core financial management topics, such as budgeting, saving, and setting financial goals?    

Discuss core financial management topics with

your clients?    

Assess your clients’ f inancial condition or
situation?    

Get help if you or your clients have questions
about financial issues?    

Refer clients to community resources such as
credit

- debt counseling and tax filing assistance?    

Know where to go for unbiased information or help in working with clients?    

Help clients manage their financial challenges?    

Provide the right financial content at the right time
in the context of your case work with clients?    

Access and use tools and materials from the
Consumer Financial Protection Bureau (CFPB) through its consumer website?    OMB Control Number: 3170

- XXXX Expiration Date: XX/XX/XXXX

Page 3 5) The Financial Empowerment Training Toolkit includes a variety of tools and information on a number of different topics. In your work, h ow
useful have you found each of the following tools and resources ?

With how many clients have you
used this tool? How useful did you and your clients find this tool?

Very
Useful Useful Somewhat
Useful Not at All
Useful

Module 2: Assessing the Situation

Tool 1

— Financial Empowerment
Self

- Assessment ______ clients  None    

Tool 2

— Opportunities for Providing Financial Empowerment ______ clients  None    

Tool 3

— Client Goals and Financial

Situation Assessment ______ clients  None    

Module 3 : Assessing the Situation

Information on When and How to Bring Up Money Topics with Clients ______ clients  None    

Module 4 : Setting Goals

Information on How to Set and
Reach Financial Goals ______ clients  None    

Module 5 : Saving for the Unexpected, Emergencies, and Goals

Tool 1

— Savings Plan ______ clients  None    

Tool 2

— Benefits and Asset Limits ______ clients  None    

Tool 3

— Finding a Safe Place for Savings ______ clients  None    OMB Control Number: 3170

- XXXX Expiration Date: XX/XX/XXXX

Page 4 With how many clients have you
used this tool? How useful did you and your clients find this tool?

Very
Useful Useful Somewhat
Useful Not at All
Useful

Module 6 : Managing Cash Flow

Tool 1

— Income and Spending
Tracker ______ clients  None    

Tool 2

— Cash Flow Budget ______ clients  None    

Tool 3

— Strategies for Increasing
Cash and Sources of Financial

Resources ______ clients  None    

Tool 4

— Strategies for Cutting Expenses and Other Uses of
Financial Resources ______ clients  None    

Tool 5

— When Cash Is Short ______ clients  None    

Module 7 : Dealing with Debt

Tool 1

— Debt Management
Worksheet ______ clients  None    

Tool 2

— Debt

- to

- Income Worksheet ______ clients  None    

Tool 3

— Debt Reduction Worksheet ______ clients  None    

Module 8 : Understanding Credit Reports and Scores

Tool 1

— Getting Your Credit Reports ______ clients  None    

Tool 2

— Getting Your Credit Scores ______ clients  None    

Tool 3

— Credit Report Review
Checklist ______ clients  None    OMB Control Number: 3170

- XXXX Expiration Date: XX/XX/XXXX

Page 5 With how many clients have you
used this tool? How useful did you and your clients find this tool?

Very
Useful Useful Somewhat
Useful Not at All
Useful

Tool 4

— Improving Credit Reports
and Scores ______ clients  None    

Module 9 : Evaluating Financial Service Providers, Products, and Services

Tool 1

— Selecting Financial Service
Providers ______ clients  None    

Tool 2

— Evaluating Financial Service
Providers ______ clients  None    

Tool 3

— Basic Definition of Financial

Services ______ clients  None    

Tool 4

— Opening an Account
Checklist ______ clients  None    

Module 10 : Protecting Consumer Rights

Tool 1

— Red Flags ______ clients  None    

Tool 2

— Protecting Your Identity ______ clients  None    

Tool 3

— Learning More about

Consumer Protection ______ clients  None    