OMB Control Number: 3170-XXXX

Expiration Date: XX/XX/XXXX

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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 instructions, 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 provided 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.

Instruments 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 organization.

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 answer to this question. 
OMB Control Number: 3170-XXXX

Expiration Date: XX/XX/XXXX

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__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

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 you 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’ financial 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

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5) The Financial Empowerment Training Toolkit includes a variety of tools and information on a number of different topics. In your work, how 

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

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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

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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    