Consumer Financial Protection Bureau Information Collection Request 

OMB Control Number 3170-0011

Web Complaint Intake Forms

• Credit Card

• Mortgage

• Bank Account or Service

• Student Loan

• Vehicle or Consumer Loan

• Credit Reporting

• Money Transfer

• Debt Collection

• Payday & Other Consumer Loans

• Prepaid

• Other Financial Services

External Party Logins

• Consumer Portal Login

• Company & Government Login

Feedback Intake Form

• Web Tell Your Story form

Paper Intake Forms

• Universal complaint intake form (English and Spanish)

• Debt collection complaint intake form (English and Spanish)

Phone complaint, inquiry and feedback intake

• Phone scripts
Log In

Form trouble?

Chat now.

File a credit card complaint

We'll forward your issue to your credit card company, give you a tracking number, and keep you

updated on the status of your complaint.

For credit card issues affecting your credit report, submit your complaint here.

Describe what happened so we can understand the issue... *

Do not include sensitive information like your name, contact information, account number, or social

security number in this field. We will collect certain personal information at a later step.

This is the what happened field

3869 characters remaining

I want the CFPB to publish this description on consumerfinance.gov so that others can learn from

my experience with this company. I understand that there is a small chance that someone may be

able to identify me based on the information I've included.

Learn more.

If you lost money, how much money did you lose? (Optional)

$

When did this happen?

Have you done any of these things to try to resolve this issue? (Optional)

1. What

happened?

2. Desired

resolution

3. My

information

4. Product

information

5. Review

Which of these best describes your issue? *

Application processing delay

(Optional)

Contacted the company

directly

Contacted the Consumer Financial Protection Bureau

previously

0

3/1/2015
previously

Contacted another government

agency

Hired an

attorney

Filed legal

action

Save

Privacy act statement OMB #3170-0011
Log In

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Chat now.

File a credit card complaint

We'll forward your issue to your credit card company, give you a tracking number, and keep you

updated on the status of your complaint.

What do you think would be a fair resolution to your issue? *

Do not include sensitive information like your name, contact information, account number, or social

security number in this field. We will collect certain personal information at a later step.

This is the desired resolution

3870 characters remaining

✓ What

happened?

2. Desired

resolution

3. My

information

4. Product

information

5. Review

Save

Privacy act statement OMB #3170-0011
Log In

Form trouble?

Chat now.

Select both boxes if submitting this complaint for a joint account. Select "Someone else" if assisting

someone in submitting a complaint. Provide your information under "My contact information" and the

other person’s information under "Someone else".

I am submitting on behalf of

File a credit card complaint

We'll forward your issue to your credit card company, give you a tracking number, and keep you

updated on the status of your complaint.

Submitting on behalf of someone else may require signed, written permission.

My contact information

Salutation (Optional)

Suffix (Optional)

State

United States

Someone else

What is your relationship to this person?*

Choose...

✓ What

happened?

✓ Desired

resolution

3. My

information

4. Product

information

5. Review

Myself Someone else

*

First name *

Last name *

Mailing address *

Apartment, suite, building (Optional)

City *

ZIP code *

Phone (Optional)

Email *

First Name

Last Name

Mailing Address

Apartment, suite, building (Optional)

City

Zip code

Phone (Optional)

Email
Salutation (Optional)

Suffix (Optional)

State

United States

Account Holder's age is (Optional)

The consumer is a servicemember or is a spouse or dependent of a servicemember. (Optional)

What is the servicemember's status?*

Choose...

What is the service?*

Choose...

What is the servicemember's rank?*

Choose...

*

Servicemember

Dependent or spouse of a

servicemember

Back Continue

First name *

Last name *

Mailing address *

Apartment, suite, building (Optional)

City *

ZIP code *

Phone (Optional)

Email (Optional)

First name

Last name

Mailing Address

Apartment, suite, building (Optional)

City

Zip code

Phone (Optional)

Email (Optional)

Privacy act statement OMB #3170-0011
Log In

Form trouble?

Chat now.

File a credit card complaint

We'll forward your issue to your credit card company, give you a tracking number, and keep you

updated on the status of your complaint.

Billing address

State

United States

For account identification only. You will not be charged.

Information about the company

The company name you entered is not in our database.

Please enter in the optional address information.

State (Optional)

United States

✓ What

happened?

✓ Desired

resolution

✓ My

information

4. Product

information

5. Review

Billing address same as mailing

address.

*

Billing address *

Apartment, suite, building (Optional)

City *

ZIP code *

Name on account

Credit card number

Company name *

Company address (Optional)

City (Optional)

ZIP code (Optional)

Billing Address

Apartment, suite, building (Optional)

City

Zip Code

Name on Account

Credit card number

Company Name

Company Address (Optional)

City (Optional)

Zip Code
Do not submit a complaint if you do not want it to be forwarded to the company you select. All

complaints submitted on this site will be sent to the company for response.

Upload any supporting documents (Optional)

Account agreements, monthly statements, proof of payment, etc.

Attach documents

Documents must be attached to your complaint before submission. Once your complaint is

submitted, you will not be able to add any further documentation. You may submit any document to

support your complaint in all digital file types except executable files (.exe).

Attach

Back Continue

Privacy act statement OMB #3170-0011
Log In

Form trouble?

Chat now.

File a credit card complaint

We'll forward your issue to your credit card company, give you a tracking number, and keep you

updated on the status of your complaint.

WHAT HAPPENED [EDIT]

Describe what happened so we can understand the issue...

This is the what happened field

Consent to Publish? Consent provided

Issue Application processing delay

If you lost money, how much money did you lose? $ 0

Date of incident 3/1/2015

Have you done any of these things to try to resolve this issue?

Contacted the company directly

Contacted the the Consumer Financial Protection Bureau previously

Contacted another government agency

Hired an attorney

Filed legal action

DESIRED RESOLUTION [EDIT]

What do you think would be a fair resolution to your issue?

This is the desired resolution

MY INFORMATION [EDIT]

Contact information

Mailing address

Mr First Name Last Name Jr

Mailing Address

Apartment, suite, building (Optional)

City DC Zip code

United States

Email Email@cfpb.gov

Phone Phone (Optional)

I am submitting on behalf of Myself Someone else

✓ What

happened?

✓ Desired

resolution

✓ My

information

✓ Product

information

5. Review
Someone else

Relationship Family member

First name Last name

Mailing Address

Apartment, suite, building (Optional)

City DC Zip code

United States

Email Email (Optional)

Phone Phone (Optional)

Servicemember information

The consumer is a Servicemember

Servicemember information

Servicemember status Active

Servicemember branch Army

Servicemember rank W01-CW5

PRODUCT INFORMATION [EDIT]

Billing address

Billing Address

Apartment, suite, building (Optional)

City DC Zip Code

United States

Credit card number ******************

Information about the company

Company Name

Company Address (Optional)

City (Optional)

Zip Code

The information given is true to the best of my knowledge and belief. I understand that the CFPB

cannot act as my lawyer, a court of law, or a financial advisor.

Submit

Privacy act statement OMB #3170-0011
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Form trouble?

Chat now.

File a mortgage complaint

We'll forward your issue to the company, give you a tracking number, and keep you updated on the

status of your complaint.

Describe what happened so we can understand the issue... *

Do not include sensitive information like your name, contact information, account number, or social

security number in this field. We will collect certain personal information at a later step.

This is the what happened field

3869 characters remaining

I want the CFPB to publish this description on consumerfinance.gov so that others can learn from

my experience with this company. I understand that there is a small chance that someone may be

able to identify me based on the information I've included.

Learn more.

Which part of the mortgage process is your issue related to? *

Are you concerned about losing your home to foreclosure?*

Please note: Filing a complaint will not automatically delay or stop a foreclosure

Have you missed any mortgage payments or are you in default on your

mAlosortgchagecek?"Yes" if your mortgage company believes you are in default or have missed payments,

even if you believe your mortgage company is in error.

Is there a date scheduled for the foreclosure sale of your home?

Yes

1. What

happened?

2. Desired

resolution

3. My

information

4. Product

information

5. Review

Yes No

Yes No

Applying for the loan

Application, originator, mortgage broker

Receiving a credit offer

Credit decision/Underwriting

Signing the agreement

Settlement process and costs

Making payments

Loan servicing, payments, escrow accounts

Problems when you are unable to pay

Loan modification, foreclosure
Did you pay a company to help you avoid

fSoormecelotismueres?called "foreclosure rescue," "foreclosure defense," "foreclosure prevention," or "loss

mitigation assistance."

Yes No

My loan is a(n)*

VA mortgage

Continue

3/1/2015

You may find this date on the "Notice of Sale" or "Order Setting Sale." When is the scheduled foreclosure sale?

Privacy act statement OMB #3170-0011
Log In

Form trouble?

Chat now.

File a mortgage complaint

We'll forward your issue to the company, give you a tracking number, and keep you updated on the

status of your complaint.

What do you think would be a fair resolution to your issue? *

Do not include sensitive information like your name, contact information, account number, or social

security number in this field. We will collect certain personal information at a later step.

This is the desired resolution field

3864 characters remaining

✓ What

happened?

2. Desired

resolution

3. My

information

4. Product

information

5. Review

Back Continue

Privacy act statement OMB #3170-0011
Log In

Form trouble?

Se Chat now. lect both boxes if submitting this complaint for a joint account. Select "Someone else" if assisting

someone in submitting a complaint. Provide your information under "My contact information" and the

other person’s information under "Someone else".

I am submitting on behalf of

File a mortgage complaint

We'll forward your issue to the company, give you a tracking number, and keep you updated on the

status of your complaint.

Submitting on behalf of someone else may require signed, written permission.

My contact information

Salutation (Optional)

Suffix (Optional)

State

United States

Someone else

What is your relationship to this person?*

Choose...

✓ What

happened?

✓ Desired

resolution

3. My

information

4. Product

information

5. Review

Myself Someone else

*

First name *

Last name *

Mailing address *

Apartment, suite, building (Optional)

City *

ZIP code *

Phone (Optional)

Email *

First Name

Last Name

Mailing Address

Apartment, suite, building (Optional)

City

Zip Code

Phone (Optional)

Email
Salutation (Optional)

Suffix (Optional)

State

United States

Account Holder's age is (Optional)

The consumer is a servicemember or is a spouse or dependent of a servicemember. (Optional)

Enter the servicemember information below.

Salutation (Optional)

Suffix (Optional)

State

United States

What is the servicemember's status?*

Choose...

What is the service?*

*

Servicemember

Dependent or spouse of a

servicemember

*

First name *

Last name *

Mailing address *

Apartment, suite, building (Optional)

City *

ZIP code *

Phone (Optional)

Email (Optional)

First name *

Middle name (Optional)

Last name *

Address *

Apartment, suite, building (Optional)

City *

ZIP code *

First name

Last name

Mailing address

Apartment, suite, building (Optional)

City

Zip Code

Phone (Optional)

Email (Optional)

First name

Middle name (Optional)

Last name

Address

Apartment, suite, building (Optional)

City

Zip Code
Choose...

What is the servicemember's rank?*

Choose...

Back Continue

Privacy act statement OMB #3170-0011
Log In

Form trouble?

Chat now.

File a mortgage complaint

We'll forward your issue to the company, give you a tracking number, and keep you updated on the

status of your complaint.

Property address

State

United States

For account identification only

Information about the company

The company name you entered is not in our database.

Please enter in the optional address information.

State (Optional)

United States

Do not submit a complaint if you do not want it to be forwarded to the company you select. All

complaints submitted on this site will be sent to the company for response.

✓ What

happened?

✓ Desired

resolution

✓ My

information

4. Product

information

5. Review

Property address same as mailing

address.

*

Property address *

Apartment, suite, building (Optional)

City *

ZIP code *

Account/Loan number (Optional)

Company name *

Company address (Optional)

City (Optional)

ZIP code (Optional)

Property Address

Apartment, suite, building (Optional)

City

Zip Code

Account/Loan Number (Optional)

Company Name

Company address (Optional)

City (Optional)

Zip code
Upload any supporting documents (Optional)

Mortgage statements, good faith estimates, loan origination documents, etc.

Attach documents

Documents must be attached to your complaint before submission. Once your complaint is

submitted, you will not be able to add any further documentation. You may submit any document to

support your complaint in all digital file types except executable files (.exe).

Attach

Back Continue

Privacy act statement OMB #3170-0011
Log In

Form trouble?

Chat now.

File a mortgage complaint

We'll forward your issue to the company, give you a tracking number, and keep you updated on the

status of your complaint.

WHAT HAPPENED [EDIT]

Describe what happened so we can understand the issue...

This is the what happened field

Consent to Publish? Consent provided

Which part of the mortgage process is your issue related to?

Problems when you are unable to pay

Are you concerned about losing your home to foreclosure? Yes No

Have you missed any mortgage payments or are you in default on your mortgage? Yes No

Is there a date scheduled for the foreclosure sale of your home? Yes When is the scheduled foreclosure sale? 3/1/2015

Did you pay a company to help you avoid foreclosure? Yes No

This is about VA mortgage

DESIRED RESOLUTION [EDIT]

What do you think would be a fair resolution to your issue?

This is the desired resolution field

MY INFORMATION [EDIT]

Contact information

Mailing address

First Name Last Name

Mailing Address

Apartment, suite, building (Optional)

City DC Zip Code

United States

Email Email@cfpb.gov

Phone Phone (Optional)

I am submitting on behalf of Myself Someone else

Someone else

✓ What

happened?

✓ Desired

resolution

✓ My

information

✓ Product

information

5. Review
Relationship Advocate

First name Last name

Mailing address

Apartment, suite, building (Optional)

City DC Zip Code

United States

Email Email (Optional)

Phone Phone (Optional)

Servicemember information

Dependent or spouse of a servicemember

Dependent information

First name Last name

Address

Apartment, suite, building (Optional)

City DC Zip Code

United States

Servicemember information

Servicemember status Retired

Servicemember branch Navy

Servicemember rank E5-E7

PRODUCT INFORMATION [EDIT]

Property address is the same as mailing address.

Account/Loan number ******************************

Information about the company

Company Name

Company address (Optional)

City (Optional) Zip code

The information given is true to the best of my knowledge and belief. I understand that the CFPB

cannot act as my lawyer, a court of law, or a financial advisor.

Submit

Privacy act statement OMB #3170-0011
Log In

Form trouble?

Chat now.

File a bank account or service complaint

We'll forward your issue to the company, give you a tracking number, and keep you updated on the

status of your complaint.

Describe what happened so we can understand the issue... *

Do not include sensitive information like your name, contact information, account number, or social

security number in this field. We will collect certain personal information at a later step.

This is the what happened field

3869 characters remaining

I want the CFPB to publish this description on consumerfinance.gov so that others can learn from

my experience with this company. I understand that there is a small chance that someone may be

able to identify me based on the information I've included.

Learn more.

Which of these best describes your issue? *

1. What

happened?

2. Desired

resolution

3. My

information

4. Product

information

5. Review

This is about a(n) *

Checking account

Confusing marketing, denial, disclosure, fees, closure, account access, interest, statements, joint

accounts

Availability of deposits, withdrawal problems and penalties, unauthorized transactions, check

cashing, payroll deposit problems, lost or missing funds, transaction holds

Disputed transaction, unauthorized card use, ATM or debit card fees, ATM problems

Problems with payments by check, card, phone or online, unauthorized or fraudulent transactions

Overdraft fees, late fees, bounced checks

Account opening, closing, or management

Deposits and withdrawals

Using a debit or ATM card

Making or receiving payments

Problems caused by my funds being low
C

ontinue

PrivacyactstatementOMB#3170-0011
Log In

Form trouble?

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File a bank account or service complaint

We'll forward your issue to the company, give you a tracking number, and keep you updated on the

status of your complaint.

What do you think would be a fair resolution to your issue? *

Do not include sensitive information like your name, contact information, account number, or social

security number in this field. We will collect certain personal information at a later step.

This is the desired resolution

3870 characters remaining

✓ What

happened?

2. Desired

resolution

3. My

information

4. Product

information

5. Review

Back Continue

Privacy act statement OMB #3170-0011
Log In

Form trouble?

Se Chat now. lect both boxes if submitting this complaint for a joint account. Select "Someone else" if assisting

someone in submitting a complaint. Provide your information under "My contact information" and the

other person’s information under "Someone else".

I am submitting on behalf of

File a bank account or service complaint

We'll forward your issue to the company, give you a tracking number, and keep you updated on the

status of your complaint.

Submitting on behalf of someone else may require signed, written permission.

My contact information

Dr

V

State

United States

Account Holder's age is (Optional)

The consumer is a servicemember or is a spouse or dependent of a servicemember. (Optional)

✓ What

happened?

✓ Desired

resolution

3. My

information

4. Product

information

5. Review

Myself Someone else

*

First name *

Last name *

Mailing address *

Apartment, suite, building (Optional)

City *

ZIP code *

Phone (Optional)

Email *

First name

Last name

Mailing address

Apartment, suite, building (Optional)

City

Zip Code

Phone (Optional)

Email
B

ack

Continue

PrivacyactstatementOMB#3170-0011
Log In

Form trouble?

Chat now.

File a bank account or service complaint

We'll forward your issue to the company, give you a tracking number, and keep you updated on the

status of your complaint.

Billing address

State

United States

For account identification only

Information about the company

The company name you entered is not in our database.

Please enter in the optional address information.

State (Optional)

United States

Do not submit a complaint if you do not want it to be forwarded to the company you select. All

complaints submitted on this site will be sent to the company for response.

✓ What

happened?

✓ Desired

resolution

✓ My

information

4. Product

information

5. Review

Billing address same as mailing

address.

*

Billing address *

Apartment, suite, building (Optional)

City *

ZIP code *

Account number (Optional)

Company name *

Company address (Optional)

City (Optional)

ZIP code (Optional)

Billing address

Apartment, suite, building (Optional)

City

Zip Code

Account number (Optional)

Company Name

Company Address (Optional)

City (Optional)

Zip Code
Upload any supporting documents (Optional)

Monthly statements, account agreements, power of attorney forms, CD certificates, etc.

Attach documents

Documents must be attached to your complaint before submission. Once your complaint is

submitted, you will not be able to add any further documentation. You may submit any document to

support your complaint in all digital file types except executable files (.exe).

Attach

Back Continue

Privacy act statement OMB #3170-0011
Log In

Form trouble?

Chat now.

File a bank account or service complaint

We'll forward your issue to the company, give you a tracking number, and keep you updated on the

status of your complaint.

WHAT HAPPENED [EDIT]

Describe what happened so we can understand the issue...

This is the what happened field

Consent to Publish? Consent provided

Product Checking account

Issue Account opening, closing, or management

DESIRED RESOLUTION [EDIT]

What do you think would be a fair resolution to your issue?

This is the desired resolution

MY INFORMATION [EDIT]

Contact information

Mailing address

Dr First name Last name V

Mailing address

Apartment, suite, building (Optional)

City DC Zip Code

United States

Email Email@cfpb.gov

Phone Phone (Optional)

Age 50

I am submitting on behalf of Myself

Age 50

PRODUCT INFORMATION [EDIT]

Billing address is the same as mailing address.

✓ What

happened?

✓ Desired

resolution

✓ My

information

✓ Product

information

5. Review
Account number *************************

Information about the company

Company Name

Company Address (Optional)

City (Optional) Zip Code

The information given is true to the best of my knowledge and belief. I understand that the CFPB

cannot act as my lawyer, a court of law, or a financial advisor.

Submit

Privacy act statement OMB #3170-0011
Log In

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Chat now.

File a student loan complaint

We'll forward your issue to the company, give you a tracking number, and keep you updated on the

status of your complaint.

Describe what happened so we can understand the issue. Include the name and location of your

school. *

Do not include sensitive information like your name, contact information, account number, or social

security number in this field. We will collect certain personal information at a later step.

This is the what happened field

3869 characters remaining

I want the CFPB to publish this description on consumerfinance.gov so that others can learn from

my experience with this company. I understand that there is a small chance that someone may be

able to identify me based on the information I've included.

Learn more.

Which of these best describes your issue? *

1. What

happened?

2. Desired

resolution

3. My

information

4. Product

information

5. Review

My loan is *

Federal loan (Stafford, Direct, consolidation, PLUS, Perkins)

Non-federal loan (Private, alternative, other student loan)

I am not sure

Denial, confusing advertising or marketing, sales tactics or pressure, financial aid services,

recruiting, fraudulent loan

Deferment, forbearance, default, bankruptcy, payment plan, refinancing

Getting a loan

Can't qualify for a loan

Qualify for a better loan than the one offered

Can't repay my loan
Making payments, getting information about my loan, managing my account

Continue

Dealing with my lender or servicer

Privacy act statement OMB #3170-0011
Log In

Form trouble?

Chat now.

File a student loan complaint

We'll forward your issue to the company, give you a tracking number, and keep you updated on the

status of your complaint.

What do you think would be a fair resolution to your issue? *

Do not include sensitive information like your name, contact information, account number, or social

security number in this field. We will collect certain personal information at a later step.

This is the desired resolution field

3864 characters remaining

✓ What

happened?

2. Desired

resolution

3. My

information

4. Product

information

5. Review

Back Continue

Privacy act statement OMB #3170-0011
Log In

Form trouble?

Se Chat now. lect both boxes if submitting this complaint for a joint account. Select "Someone else" if assisting

someone in submitting a complaint. Provide your information under "My contact information" and the

other person’s information under "Someone else".

I am submitting on behalf of

File a student loan complaint

We'll forward your issue to the company, give you a tracking number, and keep you updated on the

status of your complaint.

Submitting on behalf of someone else may require signed, written permission.

My contact information

Salutation (Optional)

Suffix (Optional)

State

United States

Account Holder's age is (Optional)

The consumer is a servicemember or is a spouse or dependent of a servicemember. (Optional)

✓ What

happened?

✓ Desired

resolution

3. My

information

4. Product

information

5. Review

Myself Someone else

*

First name *

Last name *

Mailing address *

Apartment, suite, building (Optional)

City *

ZIP code *

Phone (Optional)

Email *

First name

Last name

Mailing address

Apartment, suite, building (Optional)

City

Zip Code

Phone (Optional)

Email
B

ack

Continue

PrivacyactstatementOMB#3170-0011
Log In

Form trouble?

Chat now.

File a student loan complaint

We'll forward your issue to the company, give you a tracking number, and keep you updated on the

status of your complaint.

Billing address

State

United States

For account identification only

Information about the company

The company name you entered is not in our database.

Please enter in the optional address information.

State (Optional)

United States

Do not submit a complaint if you do not want it to be forwarded to the company you select. All

complaints submitted on this site will be sent to the company for response.

✓ What

happened?

✓ Desired

resolution

✓ My

information

4. Product

information

5. Review

Billing address same as mailing

address.

*

Billing address *

Apartment, suite, building (Optional)

City *

ZIP code *

Account/Loan number or SSN (Optional)

Company name *

Company address (Optional)

City (Optional)

ZIP code (Optional)

Billing Address

Apartment, suite, building (Optional)

City

Zip Code

Account/Loan number or SSN (Opt)

Company Name

Company address (Optional)

City (Optional)

Zip Code
Upload any supporting documents (Optional)

Account agreements, monthly statements, proof of payment, etc.

Attach documents

Documents must be attached to your complaint before submission. Once your complaint is

submitted, you will not be able to add any further documentation. You may submit any document to

support your complaint in all digital file types except executable files (.exe).

Attach

Back Continue

Privacy act statement OMB #3170-0011
Log In

Form trouble?

Chat now.

File a student loan complaint

We'll forward your issue to the company, give you a tracking number, and keep you updated on the

status of your complaint.

WHAT HAPPENED [EDIT]

Describe what happened so we can understand the issue...

This is the what happened field

Consent to Publish? Consent provided

Product Non-federal loan (Private, alternative, other student loan)

Issue Getting a loan: Can't qualify for a loan

DESIRED RESOLUTION [EDIT]

What do you think would be a fair resolution to your issue?

This is the desired resolution field

MY INFORMATION [EDIT]

Contact information

Mailing address

First name Last name

Mailing address

Apartment, suite, building (Optional)

City DC Zip Code

United States

Email Email@cfpb.gov

Phone Phone (Optional)

I am submitting on behalf of Myself

PRODUCT INFORMATION [EDIT]

Billing address

Billing address

Apartment, suite, building (Optional)

City DC Zip Code

United States

✓ What

happened?

✓ Desired

resolution

✓ My

information

✓ Product

information

5. Review
Account/Loan number or SSN ********************************

Information about the company

Company Name

Company Address (Optional)

City (Optional)

The information given is true to the best of my knowledge and belief. I understand that the CFPB

cannot act as my lawyer, a court of law, or a financial advisor.

Submit

Privacy act statement OMB #3170-0011
Log In

Form trouble?

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File a vehicle loan or consumer loan complaint

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2. Desired

resolution

3. My

information

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information

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My loan is a(n) *

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Repossession, deficiency, bankruptcy, default

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payoff, fraud

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Billing address same as mailing

address.

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DESIRED RESOLUTION [EDIT]

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MY INFORMATION [EDIT]

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PRODUCT INFORMATION [EDIT]

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information

✓ Product

information

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Account terms

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Account status

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Personal information

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Public record

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received a final response?

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information

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Information about the credit reporting company

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DESIRED RESOLUTION [EDIT]

What do you think would be a fair resolution to your issue?

This is the desired resolution field

CONSUMER INFORMATION [EDIT]

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Phone Phone (Optional)

I am submitting on behalf of Myself

✓ What

happened?

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information

✓ Desired

resolution

✓ Consumer

information

5. Review
I authorize and direct any consumer reporting agency to furnish a copy of my consumer report to

the CFPB for the purpose of responding to and investigating my consumer complaint.

The information given is true to the best of my knowledge and belief. I understand that the CFPB

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I want the CFPB to publish this description on consumerfinance.gov so that others can learn from

my experience with this company. I understand that there is a small chance that someone may be

able to identify me based on the information I've included.

Learn more.

Which of these best describes your issue? *

1. What

happened?

2. Desired

resolution

3. My

information

4. Product

information

5. Review

This is about a(n) *

Domestic (US) money transfer

Transfer amounts, fees, exchange rates, taxes, etc.

Unauthorized transaction, cancellation, refund, etc.

Advertising or marketing, pricing, privacy, etc.

Money was not available when promised

Wrong amount charged or received

Incorrect/missing disclosures or info

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File a money transfer complaint

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State

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information

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information

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Sender Recipient Filing on behalf of someone else

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What company was used to send the money?

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State (Optional)

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complaints submitted on this site will be sent to the company for response.

Account number associated with the company used for this transfer

Where did the transaction take place? (Optional)

Online

Sender Information

Salutation (Optional)

Suffix (Optional)

✓ What

happened?

✓ Desired

resolution

✓ My

information

4. Product

information

5. Review

Company name *

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City (Optional)

ZIP code (Optional)

Account number (Optional)

Website or name of mobile app (Optional)

First name *

Middle name (Optional)

Last name *

Company name

Company Address

City

Zip Code

Account number (Optional)

Website or name of mobile app (Optional)

First name

Middle name (Optional)

Last name
USD United States Dollar

USD United States Dollar

United States

State

How much was transferred? (Optional)

Date of transfer (Optional)

What is the transfer ID or transaction number? (Optional)

Transaction number or transfer ID may be found on money transfer receipt

Funds promised date (Optional)

Amount of error (Optional)

Date issue occurred (Optional)

Person receiving funds

How was the transfer received? (Optional)

Deposited or credited to an account

United States

*

Amount must be in 0.00 format

When money was sent

When funds expected

Amount must be in 0.00 format

When error was found

Mailing address (Optional)

Apartment, suite, building (Optional)

City (Optional)

ZIP code (Optional)

Phone (Optional)

Email (Optional)

0.00

ID or number

0.00

Company name *

Mailing address (Optional)

Apartment, suite, building (Optional)

City (Optional)

Zip code

Phone (Optional)

Email (Optional)

0.00

ID or number

0.00

Company name

3/1/2015

3/31/2015

3/1/2015
State

Account number associated with the company that received this transfer

Salutation (Optional)

Suffix (Optional)

United States

State

Upload any supporting documents (Optional)

Copies of receipts, disclosures provided for transaction, account statements,

advertisements/marketing letters, etc.

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*

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Website or name of mobile app (Optional)

Account number (Optional)

First name *

Middle name (Optional)

Last name *

Mailing address (Optional)

Apartment, suite, building (Optional)

City (Optional)

ZIP code (Optional)

Phone (Optional)

Email (Optional)

Company address (Optional)

City (Optional)

Zip code

Website or name of mobile app (Optional)

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First name

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WHAT HAPPENED [EDIT]

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This is the what happened field

Consent to Publish? Consent provided

This is about a(n) Domestic (US) money transfer

Which of these best describes your issue? Money was not available when promised

DESIRED RESOLUTION [EDIT]

What do you think would be a fair resolution to your issue?

This is the desired resolution field

CONSUMER INFORMATION [EDIT]

Contact information

Mailing address

First name Middle name (Optional) Last name

Mailing address

Apartment, suite, building (Optional)

City DC Zip Code

United States

Email Email@cfpb.gov

Phone Phone (Optional)

I am submitting on behalf of Myself

PRODUCT INFORMATION [EDIT]

What company was used to send the money?

Company name

Company Address

City Zip Code

✓ What

happened?

✓ Desired

resolution

✓ My

information

✓ Product

information

5. Review
Account number Account number (Optional)

Where did the transaction take place? Online Website or name of mobile app Website or name of mobile app (Optional)

Sender Information

First name Middle name (Optional) Last name

Mailing address (Optional)

Apartment, suite, building (Optional)

City (Optional) DC Zip code

United States

Phone (Optional)

Email@cfpb.gov

How much was transferred? 0.00 USD United States Dollar

Date of transfer 3/1/2015

What is the transfer ID or transaction number? ID or number

Funds promised date 3/31/2015

Amount of error 0.00 USD United States Dollar

Date issue occurred 3/1/2015

Person receiving funds

How was the transfer received? Deposited or credited to an account

Company name

Company address (Optional)

City (Optional) DC Zip code

United States Website or name of mobile app (Optional)

Account number (Optional)

First name Middle name (Optional) Last name

Mailing address (Optional)

Apartment, suite, building (Optional)

City (Optional) DC Zip Code

United States

Phone (Optional)

Email@cfpb.gov

The information given is true to the best of my knowledge and belief. I understand that the CFPB

cannot act as my lawyer, a court of law, or a financial advisor.

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Why do we need this?

Why do we need this?

What happened

What type of debt

is this?

Which of these

best describes

your issue?

What phone

number are they

calling?

(Optional)

Describe what

happened so we

can understand

the issue...

Desired resolution

What do you think

would be a fair

resolution to your

issue?

WHAT HAPPENED?

COMPANY INFORMATION

Incomplete

MY INFORMATION

Incomplete

REVIEW AND SUBMIT

Incomplete

Credit card

Medical

Auto

Federal student loan

Non-federal student loan

Mortgage

Payday loan

Other (i.e. phone, health club, etc.)

I do not know

Communication tactics

Frequent or repeated calls

Called outside of 8am-9pm

Used obscene, profane or other abusive language

Threatened to take legal action

Called after sent written cease of communication notice

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I want the CFPB to publish this description on consumerfinance.gov so

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on the information I've included. Learn more

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Who's contacting you about this debt?

Debt collection

company name:

Address:

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Country:

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Zip code:

(Optional)

City:

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State:

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Phone number:

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Representative

name or ID:

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Account number:

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Do you know where this debt came from?

Do you know

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Address 2:

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WHAT HAPPENED?

I do not know the

debt collection

company name

Company Name

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Same company A different company I don't know

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company name

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Country:

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State:

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COMPANY INFORMATION

MY INFORMATION

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REVIEW AND SUBMIT

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Last four digits of

Social Security

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Age:

(Optional)

Contact information

Address:

Address 2:

(Optional)

Country: Zip code:

City: State:

Phone Number:

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Email:

WHAT HAPPENED?

COMPANY INFORMATION

MY INFORMATION

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REVIEW AND SUBMIT

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Military affiliation

The consumer is

now or was:

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(Choose all that apply)

Salutation:

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(Optional)

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Address:

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Country: Zip code:

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Status: Branch:

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WHAT HAPPENED? Edit this section

What type of debt is this?

Credit card

Which of these best describes your issue?

Called outside of 8am-9pm

Describe what happened so we can understand the issue...

This is the what happened field

Consent to Publish?

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What do you think would be a fair resolution to your issue?

This is the desired resolution field

COMPANY INFORMATION Edit this section

Debt collection company

Company Name

Do you know where this debt came from?

A different company

Original creditor

Company Name

MY INFORMATION Edit this section

Your name

First Name Last Name

The last four digits of your SSN

SSN

Mailing address

Address

City DC 20000

United States

Contact information

email@cfpb.gov

Your age is

25

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WHAT HAPPENED?

COMPANY INFORMATION

MY INFORMATION

REVIEW AND SUBMIT

Incomplete
The information given is true to the best of my knowledge and

belief. I understand that the CFPB cannot act as my lawyer, a court

of law, or a financial advisor.

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Why do we need this?

Why do we need this?

If your complaint concerns lender collection practices on your loan, you

should submit a Debt Collection complaint.

What happened

Which type of

loan is your

complaint about?

Which of these

best describes

your issue?

Describe what

happened so we

can understand

the issue...

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What do you think

would be a fair

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WHAT HAPPENED?

Incomplete

MY INFORMATION

Incomplete

COMPANY INFORMATION

Incomplete

REVIEW AND SUBMIT

Incomplete

Installment loan

Loan paid in regular fixed payments, Rent-to-Own, appliances, medical, etc

Pawn loan

Loan secured by personal property

Title loan

Loan usually secured by a vehicle title

Payday loan

Short-term loan or cash advance

Charged fees or interest I didn't expect

Can't stop lender from charging my bank account

Received a loan I didn't apply for

Applied for a loan, but didn't receive money

Lender charged my bank account on wrong day or for wrong

amount

Lender didn't credit payment to my account

Can't contact lender

Lender repossessed or sold the vehicle

Lender damaged or destroyed vehicle

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I want the CFPB to publish this description on consumerfinance.gov so

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that there is a small chance that someone may be able to identify me

based on the information I've included. Learn more

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resolution to your

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3864 characters remaining

Do not include sensitive information like your name, contact information,

account number, or social security number in this field. We will collect

certain personal information at a later step.

Have questions? Need help with this form? (855) 411-2372 An official website of the United States government

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Why do we need this?

Why do we need this?

Why do we need this?

Who is the borrower?

Who is the

borrower of the

loan?

What is your

relationship to the

borrower?

Borrower information

Salutation

(Optional)

First name Middle

(Optional)

Last name Suffix

(Optional)

Address

Address 2

(Optional)

Country Zip code

City State

Age

(Optional)

Your information

Salutation

(Optional)

First name Middle

(Optional)

Last name Suffix

(Optional)

Address

WHAT HAPPENED?

MY INFORMATION

Incomplete

COMPANY INFORMATION

Incomplete

REVIEW AND SUBMIT

Incomplete

I am the

borrower

I am submitting on behalf of the

borrower

Housing counselor

Choose...

First name

Last name Choose...

Address

United States

Choose...

Choose...

Choose...
If you enter your email

address here, the CFPB will

send you all further

communications by email.

Why do we need this?

CONTINUE

Address 2

(Optional)

Country Zip code

City State

Phone number

(Optional)

Email

Military affiliation

The borrower is

(Optional)

(Choose all that apply)

Current status Branch

Rank

United States

Choose...

A servicemember or

veteran

The spouse or dependent of a servicemember or

veteran

Choose... Choose...

Choose...

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Why do we need this?

Why do we need this?

Why do we need this?

CONTINUE

Loan details

Where did you

get the loan?

(Optional)

In which state is

the store located?

(Optional)

Loan number

(Optional)

Company details

Company name

Address

(Optional)

Country

(Optional)

Zip code

(Optional)

City

(Optional)

State

(Optional)

Upload any supporting documents

Attach documents

(Optional)

WHAT HAPPENED?

MY INFORMATION

COMPANY INFORMATION

REVIEW AND SUBMIT

Incomplete

In person / at a store (even if you applied online)

Online

This is important because

different states have

different lending laws.

Choose...

Company Name

United States

Choose...

SELECT FILE

We accept all file formats except executable files (.exe)

Have questions? Need help with this form? (855) 411-2372 An official website of the United States government

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An official website of the United States Government

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Form trouble? Chat now.

Please review your information below before submitting.

You can return to any section to make changes by clicking 'Edit this

section'.

WHAT HAPPENED Edit this section

Which type of loan

is your complaint

about?

Which of these

best describes

your issue?

Describe what

happened so we

can understand

the issue...

Consent to

Publish?

What do you think

would be a fair

resolution to your

issue?

MY INFORMATION Edit this section

Your name

Address

Email

Phone

(Optional)

Who is the

borrower of the

loan?

WHAT HAPPENED?

MY INFORMATION

COMPANY INFORMATION

REVIEW AND SUBMIT

Incomplete Title loan

Can't contact lender

This is the what happened field

Consent not provided

This is the desired resolution field

First Name Last Name

Address

City DC 20000

United States

Email@cfpb.gov

I am the borrower
The information given is true to the best of my knowledge and

belief. I understand that the CFPB cannot act as my lawyer, a court

of law, or a financial advisor.

SUBMIT

loan?

Age

(Optional)

COMPANY INFORMATION Edit this section

Where did you get

the loan?

(Optional)

Loan company

Loan number

(Optional)

Supporting

documents

(Optional)

In person / at a store

District Of Columbia

Company Name

United States

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Why do we need this?

Why do we need this?

CONTINUE

What happened

Which of these

best describes

your issue?

Describe what

happened so we

can understand

the issue...

Desired resolution

What do you think

would be a fair

resolution to your

issue?

WHAT HAPPENED?

MY INFORMATION

Incomplete

COMPANY INFORMATION

Incomplete

REVIEW AND SUBMIT

Incomplete

Managing, opening, or closing your account

Fees

Unauthorized transactions or other transaction issues

Advertising, marketing or disclosures

Adding money

Overdraft, savings or rewards features

Fraud or scam

This is the what happened field

3869 characters remaining

Do not include sensitive information like your name, contact information,

account number, or social security number in this field. We will collect

certain personal information at a later step.

I want the CFPB to publish this description on consumerfinance.gov so

that others can learn from my experience with this company. I understand

that there is a small chance that someone may be able to identify me

based on the information I've included. Learn more

This is the desired resolution field

3864 characters remaining

Do not include sensitive information like your name, contact information,

account number, or social security number in this field. We will collect

certain personal information at a later step.
Have questions? Need help with this form? (855) 411-2372 An official website of the United States government

Privacy act statement | OMB #3170-0011
An official website of the United States Government

Submit a prepaid card complaint

Form trouble? Chat now.

Why do we need this?

Why do we need this?

If you enter your email

address here, the CFPB will

send you all further

communications by email.

Why do we need this?

Who is the cardholder?

Who is the

cardholder?

Your information

Salutation

(Optional)

First name Middle

(Optional)

Last name Suffix

(Optional)

Address

Address 2

(Optional)

Country Zip code

City State

Email

Phone number

(Optional)

Age

(Optional)

Military affiliation

I am

(Optional)

(Choose all that apply)

WHAT HAPPENED?

MY INFORMATION

Incomplete

COMPANY INFORMATION

Incomplete

REVIEW AND SUBMIT

Incomplete

I am the

cardholder

I am submitting on behalf of the

cardholder

Choose...

Choose...

United States

Choose...

A servicemember or

veteran

The spouse or dependent of a servicemember or

veteran
CONTINUE

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An official website of the United States Government

Submit a prepaid card complaint

Why do we need this?

Why do we need this?

Why do we need this?

CONTINUE

Card details

Which type of

card is your

complaint about?

Company details

Company name

Address

(Optional)

Country

(Optional)

Zip code

(Optional)

City

(Optional)

State

(Optional)

Phone number

(Optional)

Upload any supporting documents

Attach documents

(Optional)

Form trouble? Chat now.

WHAT HAPPENED?

MY INFORMATION

COMPANY INFORMATION

REVIEW AND SUBMIT

Incomplete

Government benefit payment card

Used for receiving Social Security, unemployment compensation or a tax refund

Electronic Benefit Transfer / EBT card

Used for receiving welfare payments like WIC,TANF, & SNAP

ID prepaid card

Prepaid card attached to a student or other ID

Transit card

A transit card used for shopping anywhere

Gift or merchant card

Gift, loyalty or promotional card isued by a store

General purpose card

Used for shopping anywhere

Mobile wallet

Money held in a mobile, online or virtual account

Payroll card

Used for receiving your paycheck from your employer

Other special purpose card

Used for health care, insurance, rebates, phone or disaster assistance

Company Name

United States

Choose...

SELECT FILE

We accept all file formats except executable files (.exe)
Have questions? Need help with this form? (855) 411-2372 An official website of the United States government

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An official website of the United States Government

Submit a prepaid card complaint

Form trouble? Chat now.

Please review your information below before submitting.

You can return to any section to make changes by clicking 'Edit this

section'.

WHAT HAPPENED Edit this section

Which of these

best describes

your issue?

Describe what

happened so we

can understand

the issue...

Consent to

Publish?

What do you think

would be a fair

resolution to your

issue?

MY INFORMATION Edit this section

Your name

Address

Email

Phone

(Optional)

Who is the

cardholder?

Age

(Optional)

WHAT HAPPENED?

MY INFORMATION

COMPANY INFORMATION

REVIEW AND SUBMIT

Incomplete Fees

This is the what happened field

Consent not provided

This is the desired resolution field

First Name Last Name

Address

City DC 20000

United States

Email@cfpb.gov

I am the cardholder
The information given is true to the best of my knowledge and

belief. I understand that the CFPB cannot act as my lawyer, a court

of law, or a financial advisor.

SUBMIT

COMPANY INFORMATION Edit this section

Which type of card

is your complaint

about?

Prepaid card

company

Supporting

documents

(Optional)

General purpose card

Company Name

United States

Have questions? Need help with this form? (855) 411-2372 An official website of the United States government

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Submit an other financial service complaint

Why do we need this?

Why do we need this?

What happened

Which type of

service is your

complaint about?

Which of these

best describes

your issue?

Describe what

happened so we

can understand

the issue...

Desired resolution

What do you think

would be a fair

resolution to your

issue?

Form trouble? Chat now.

WHAT HAPPENED?

MY INFORMATION

Incomplete

COMPANY INFORMATION

Incomplete

REVIEW AND SUBMIT

Incomplete

Check cashing

A store that cashes a check for a fee

Credit repair

Services for improving your credit report

Debt settlement

Services for reducing your debt balance

Foreign currency exchange

Transactions that convert money between currencies

Money order

A prepaid check for a set amount of money

Refund anticipation check

A check paid to you by a bank or company with your expected tax refund

Traveler’s/Cashier’s checks

A check with secured funds from a bank or other financial institution

Advertising and marketing

Customer service/Customer relations

Disclosures

Excessive fees

Unexpected/Other fees

Incorrect exchange rate

Fraud or scam

This is the what happened field

3869 characters remaining

Do not include sensitive information like your name, contact information,

account number, or social security number in this field. We will collect

certain personal information at a later step.

I want the CFPB to publish this description on consumerfinance.gov so

that others can learn from my experience with this company. I understand

that there is a small chance that someone may be able to identify me

based on the information I've included. Learn more

This is the desired resolution field
CONTINUE

3864 characters remaining

Do not include sensitive information like your name, contact information,

account number, or social security number in this field. We will collect

certain personal information at a later step.

Have questions? Need help with this form? (855) 411-2372 An official website of the United States government

Privacy act statement | OMB #3170-0011
An official website of the United States Government

Submit an other financial service complaint

Form trouble? Chat now.

Why do we need this?

Why do we need this?

If you enter your email

address here, the CFPB will

send you all further

communications by email.

Why do we need this?

Who received this service

Who received this

service?

Your information

Salutation

(Optional)

First name Middle

(Optional)

Last name Suffix

(Optional)

Address

Address 2

(Optional)

Country Zip code

City State

Email

Phone number

(Optional)

Age

(Optional)

Military affiliation

I am

(Optional)

(Choose all that apply)

WHAT HAPPENED?

MY INFORMATION

Incomplete

COMPANY INFORMATION

Incomplete

REVIEW AND SUBMIT

Incomplete

I received this

service

I am submitting on behalf of the person who received this

service

Choose...

Choose...

United States

Choose...

A servicemember or

veteran

The spouse or dependent of a servicemember or

veteran
CONTINUE

Have questions? Need help with this form? (855) 411-2372 An official website of the United States government

Privacy act statement | OMB #3170-0011
An official website of the United States Government

Submit an other financial service complaint

Form trouble? Chat now.

Why do we need this?

Why do we need this?

CONTINUE

Company details

Company name

Address

(Optional)

Country

(Optional)

Zip code

(Optional)

City

(Optional)

State

(Optional)

Phone number

(Optional)

Upload any supporting documents

Attach documents

(Optional)

WHAT HAPPENED?

MY INFORMATION

COMPANY INFORMATION

REVIEW AND SUBMIT

Incomplete

Company Name

United States

Choose...

SELECT FILE

We accept all file formats except executable files (.exe)

Have questions? Need help with this form? (855) 411-2372 An official website of the United States government

Privacy act statement | OMB #3170-0011
An official website of the United States Government

Submit an other financial service complaint

Form trouble? Chat now.

Please review your information below before submitting.

You can return to any section to make changes by clicking 'Edit this

section'.

WHAT HAPPENED Edit this section

Which type of

service is your

complaint about?

Which of these

best describes

your issue?

Describe what

happened so we

can understand

the issue...

Consent to

Publish?

What do you think

would be a fair

resolution to your

issue?

MY INFORMATION Edit this section

Your name

Address

Email

Phone

(Optional)

Who received the

service?

WHAT HAPPENED?

MY INFORMATION

COMPANY INFORMATION

REVIEW AND SUBMIT

Incomplete Foreign currency exchange

Disclosures

This is the what happened field

Consent not provided

This is the desired resolution field

First Name Last Name

Address

City DC 20000

United States

Email@cfpb.gov

I received the service
The information given is true to the best of my knowledge and

belief. I understand that the CFPB cannot act as my lawyer, a court

of law, or a financial advisor.

SUBMIT

Age

(Optional)

COMPANY INFORMATION Edit this section

Financial service

company

Supporting

documents

(Optional)

Company Name

United States

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Privacy act statement | OMB #3170-0011
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g In

Email Passw

ord

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Notregisteredyet?Setyourpassword

Log In
This is a Consumer Financial Protection Bureau (CFPB)

information system. The CFPB is an independent agency of the

United States Government. CFPB information systems are

provided for the processing of official information only.

Unauthorized or improper use of this system may result in

administrative action, as well as civil and criminal penalties.

Because this is a CFPB information system, you have no

reasonable expectation of privacy regarding any communication

or data transiting or stored on this information system. All data

contained on CFPB information systems is owned by CFPB and

your use of the CFPB information system serves as your consent

to your usage being monitored, intercepted, recorded, read,

copied, captured or otherwise audited in any manner, by

authorized personnel, including but not limited to employees,

contractors, and/or agents of the United States Government.

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Password

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Tell your story

This is not a complaint form. Go here for complaints

Tell us your story, good or bad, about your experience with consumer financial products. Your story

will help inform how we work to protect consumers and create a fairer marketplace.

Describe what happened... *

Do not include sensitive information like your name, contact information, account number, or social

security number in this field. You can provide your contact information below.

This is what happened

Submit anonymously

Is this about something you saw while working for a financial company? *

Mortgage, credit card, student loan, etc.

Yes No

Tell your story

Tag your issue

Email

ZIP code

First name

Last name

Phone

Tag your issue

Email

Zip Code

First name

Last name

Phone
COMPLAINT NUMBER

NEED HELP WITH THIS FORM?

(855) 411-CFPB (2372) VERSION 3.2 / 2015

ABOUT A FINANCIAL PRODUCT OR SERVICE

Submit a complaint

The complaint process

You submit a complaint about an issue you have with a company about a 

consumer financial product or service. You will receive email updates and can 

log in to track the status of your complaint.

Complaint 

submitted

Review 

and route

Company 

response

Consumer 

review

Review and 

investigate

Analyze 

and report

The company will review your complaint, communicate with you as needed, and 

report back about the steps taken or that will be taken on the issue you identify 

in your complaint.

We will let you know when the company responds. You can review that response 

and give us feedback.

Complaint data is shared with state and federal law enforcement agencies. 

Complaints tell us about business practices that may pose risks to consumers. 

If we need more information, we’ll reach out and let you know. 

Complaints help with our work to supervise companies, enforce federal consumer 

financial laws, and write better rules and regulations. We also report to Congress 

about the complaints we receive and post some consumer complaint data.

We'll forward your complaint to the company and work to get a response from 

them. If we find that another government agency would be better able to assist, 

we will forward your complaint to them and let you know.

How to submit

Online (recommended)

consumerfinance.gov/complaint

Over the phone

(855) 411-CFPB (2372)

By mail

Consumer Financial Protection Bureau

PO Box 4503, Iowa City, IA 52244

By fax

(855) 237-2392
COMPLAINT NUMBER

SUBMIT A COMPLAINT ABOUT A FINANCIAL PRODUCT OR SERVICE 1 OF7

NEED HELP WITH THIS FORM?

(855) 411-CFPB (2372)

What happened?

We want to understand your situation to help pinpoint what went wrong. Including facts and details like dates and 

where transactions happened can help. 

Describe what 

happened so we 

can understand the 

issue...

Avoid including any of 

your personal contact 

information here. 

We will collect your 

personal information 

at a later step.

What do you think 

would be a fair 

resolution to your 

issue?

Avoid including any of 

your personal contact 

information here. 

We will collect your 

personal information 

at a later step.

Desired resolution

We want to understand what you think would be a fair resolution to the issue. We’ll forward this information to the 

company along with your description of what happened so that all parties involved can understand what you’re 

looking for.

1

2
COMPLAINT NUMBER

SUBMIT A COMPLAINT ABOUT A FINANCIAL PRODUCT OR SERVICE 2 OF7

NEED HELP WITH THIS FORM?

(855) 411-CFPB (2372)

Estimate the 

total dollar value 

of your loss based 

on what you know 

right now.

OPTIONAL

What is your 

complaint about?

CHOOSE ONE

In a few words, 

what is your issue 

with this product 

or service?

BANK ACCOUNT OR SERVICE

CREDIT CARD

CREDIT REPORTING

MONEY TRANSFER

MORTGAGE

PAYDAY LOAN

PREPAID CARD

STUDENT LOAN

VEHICLE LOAN OR LEASE

OTHER CONSUMER LOAN

OTHER FINANCIAL SERVICE

3

4

Product or service type

When did this MM DD YYYY

happen?

OPTIONAL

Have you done any 

of these things to 

try to resolve this 

issue?

OPTIONAL

CONTACTED COMPANY 

DIRECTLY

CONTACTED ANOTHER 

GOVERNMENT AGENCY

FILED LEGAL ACTION

CONTACTED CONSUMER 

FINANCIAL PROTECTION 

BUREAU

HIRED AN ATTORNEY OTHER

$

Provide details such as the names of any government agencies contacted, the dates contacted, any 

case numbers, contact information, current status, attorney contact information (if applicable), etc.

5

6

7
COMPLAINT NUMBER

SUBMIT A COMPLAINT ABOUT A FINANCIAL PRODUCT OR SERVICE 3 OF7

NEED HELP WITH THIS FORM?

(855) 411-CFPB (2372)

Have you missed 

any mortgage 

payments or are 

you in default on 

your mortgage?

OPTIONAL

Mortgage questions, if applicable

Filing a complaint will not automatically delay or stop a foreclosure. 

If you are not submitting a mortgage complaint, skip this page.

Are you concerned 

about losing 

your home to 

foreclosure?

OPTIONAL

Is there a date 

scheduled for the 

foreclosure sale of

your home?

OPTIONAL

Did you pay 

a company to 

help you avoid 

foreclosure?

OPTIONAL

If yes, what 

is the date of 

the scheduled 

foreclosure sale?

OPTIONAL

Also check “Yes” if your mortgage 

company believes you are in default 

or have missed payments, even if 

you believe your mortgage company 

is in error.

If a foreclosure sale has been scheduled, 

you might have received a “Notice of 

Sale” or “Order Setting Sale.”

Please provide the exact date, if you can. 

This should be on the “Notice of Sale” or 

the “Order Setting Sale.”

Sometimes called “foreclosure rescue,” 

“foreclosure defense,” “foreclosure 

prevention,” or “loss mitigation 

assistance.” 

YES

YES

YES

YES

NO

NO

NO

DON’T KNOW

NO

10a

11

10

9

8

MM DD YYYY
COMPLAINT NUMBER

SUBMIT A COMPLAINT ABOUT A FINANCIAL PRODUCT OR SERVICE 4 OF7

NEED HELP WITH THIS FORM?

(855) 411-CFPB (2372)

Account holder’s 

information

Account number

Contact 

information of 

person submitting 

this complaint

If you are submitting 

on behalf of someone 

else, include your 

information here. 

We’ll use it to contact 

you about the status 

of this complaint.

FIRST NAME

FIRST NAME

LAST NAME

LAST NAME

SUFFIX

SUFFIX

EMAIL

EMAIL

AGE

PHONE NUMBER

PHONE NUMBER

I am submitting 

on behalf of: 

MYSELF FILL OUT QUESTIONS 13, 13A & 14

SOMEONE ELSE FILL OUT QUESTIONS 13, 13A, 14 & 15

12

13

15

14

STREET

STREET

CITY

CITY

COUNTRY

COUNTRY

STATE

STATE

ZIP CODE

ZIP CODE

Account 

holder’s age

OPTIONAL

Personal information

13a
COMPLAINT NUMBER

SUBMIT A COMPLAINT ABOUT A FINANCIAL PRODUCT OR SERVICE 5 OF7

NEED HELP WITH THIS FORM?

(855) 411-CFPB (2372)

Attach any 

supporting 

documents

Please attach copies of any documents related to your case. Seeing the full versions of 

documents like contracts, letters, monthly statements, and transaction receipts is the best 

way for us to really understand your case. Do not include original versions.

Company name

Company address

OPTIONAL

Phone number

OPTIONAL

Website

OPTIONAL

Information about the company

16

STREET

CITY STATE ZIP CODE COUNTRY

16a

16b

16c
COMPLAINT NUMBER

SUBMIT A COMPLAINT ABOUT A FINANCIAL PRODUCT OR SERVICE 6 OF7

NEED HELP WITH THIS FORM?

(855) 411-CFPB (2372)

ACTIVE

RESERVE

NATIONAL GUARD

RETIRED

VETERAN

Servicemember 

personal 

information

OPTIONAL

The account holder 

is now or was:

OPTIONAL,

CHECK ALL THAT APPLY

Service details

OPTIONAL,

CHOOSE ONE 

IN EACH COLUMN

There are certain protections that apply to servicemembers and their spouses and dependents. 

If you have no affiliation with the military, skip this page.

A SERVICEMEMBER

THE SPOUSE / DEPENDENT OF A SERVICEMEMBER

Current status Branch Rank

ARMY

NAVY

MARINES

AIR FORCE

COAST GUARD

PUBLIC HEALTH SERVICE

NATIONAL OCEANIC & 

ATMOSPHERIC ADMIN

E1 - E4

E5 - E7

E8 - E9

O1 - O3

O4 - O6

O7 - O10

W01 - CW5

FILL OUT QUESTION 17A

FILL OUT QUESTIONS 17A & 17B

FIRST NAME LAST NAME SUFFIX

STREET

CITY STATE ZIP CODE COUNTRY

Military affiliation, if applicable

17

17a

17b
COMPLAINT NUMBER

SUBMIT A COMPLAINT ABOUT A FINANCIAL PRODUCT OR SERVICE 7 OF7

NEED HELP WITH THIS FORM?

(855) 411-CFPB (2372)

The information given is true to the best of my knowledge and belief. 

I understand that the CFPB cannot act as my lawyer, a court of law or a financial advisor.

Certify

The information you provide will permit the Consumer 

Financial Protection Bureau to respond to your complaint 

or inquiry about companies and services we supervise. 

Information about your complaint or inquiry (including 

your personally identifiable information) may be shared:

▪	 with the entity that is the subject of your complaint;

▪	 with third parties as necessary to get information 

relevant to resolving a complaint;

▪	 with a court, a part in litigation, a magistrate, an 

adjudicative body or administrative tribunal in the 

course of a proceeding or the Department of Justice;

▪	 with other federal or state agencies or regulatory 

authorities for enforcement and statutory purposes; 

and

▪	 with contractors, agents, and others authorized by 

the CFPB to receive this information.

We may also share your complaint or inquiry (but not 

your personally identifiable information) with the public 

through a public complaint database. 

This collection of information is authorized by 12 U.S.C. § 

5493.

You are not required to file a complaint or share any 

identifying information, including your social security 

number, and you may withdraw your complaint at any 

time. However, if you do not include the requested 

information, the CFPB may not be able to act on your 

complaint.

This is how we accept complaints. You’re not required to 

fill out this form if you don’t want to submit a complaint. 

We estimate that it takes about 7 to 10 minutes to finish 

completing the form. Our OMB control number for this 

form is 3170-0011 and expires on 5/31/2015. Comments 

or suggestions? Email us at PRA@cfpb.gov.

Privacy Act Statement

Notice of Consumer Information Collection
NÚMERO DE QUEJA

¿NECESITA AYUDA CON ESTE FORMULARIO?

(855) 411-CFPB (2372) VERSIÓN 3.2 / 2015

SOBRE PRODUCTOS O SERVICIOS FINANCIEROS

Formulario de queja

Después de presentar una queja

Usted presenta una queja sobre un problema que tenga con una empresa 

acerca de un producto o servicio financiero de consumo. Usted recibirá 

actualizaciones por correo electrónico y podrá entrar al sistema para darle 

seguimiento al estado de su queja.

Presentación 

de la queja

Revisión y 

proceso

Respuesta de

la empresa

Revisión del

consumidor

Revisión e

investigación

Análisis e

informe

La empresa revisará su queja, se comunicará con usted cuando sea necesario y le 

informará Acerca de las medidas que se tomaron o que se tomarán en respuesta a 

su queja. En estos momentos, nuestros informes están en inglés, pero nos puede 

llamar al (855) 411-2372 para recibir ayuda de una persona que habla español.

Le informaremos sobre la respuesta de la empresa cuando recibamos la misma. 

Usted podrá revisar la respuesta y darnos su opinión.

Los datos de las quejas se comparten con las autoridades estatales y federales. 

Las quejas nos informan sobre las prácticas comerciales que creen riesgos para 

los consumidores ocasionar riesgos a los consumidores. Si necesitamos más 

información, se lo haremos saber.

Las quejas ayudan con nuestro trabajo para supervisar a las empresas, hacer 

cumplir las leyes federales de protección al consumidor y redactar mejores 

normas y reglamentos. Asimismo, informamos al Congreso acerca de las quejas 

que recibimos y publicamos algunos datos de quejas de los consumidores.

Enviaremos su queja a la empresa y trabajaremos para obtener una respuesta. 

Si consideramos que otra agencia del gobierno está en mejores condiciones de 

ayudar, le enviaremos su queja a la misma y se lo informaremos.

Cómo presentar una queja

Por Internet (recomendado)

consumerfinance.gov/complaint

Por teléfono

(855) 411-CFPB (2372)

Por correo

Oficina para la Protección Financiera del Consumidor

PO Box 4503, Iowa City, IA 52244

Por fax

(855) 237-2392
NÚMERO DE QUEJA

FORMULARIO DE QUEJA SOBRE PRODUCTOS O SERVICIOS FINANCIEROS 1 DE7

¿NECESITA AYUDA CON ESTE FORMULARIO?

(855) 411-CFPB (2372)

¿Qué pasó?

Queremos entender su situación para poder identificar con precisión el problema que dio lugar a su queja. Si usted 

nos proporciona los detalles de lo ocurrido —como las fechas y lugares de las transacciones; entonces podremos

entender mejor su queja.

Describa lo que 

pasó, para que 

podamos entender 

el problema.

No incluya aquí 

ninguna de su 

información de 

contacto personal. 

Le pediremos esta 

información en un 

paso posterior. 

¿Qué piensa usted 

que sería una 

resolución justa 

del problema?

No incluya aquí 

ninguna de su 

información de 

contacto personal. 

Le pediremos esta 

información en un 

paso posterior.

¿Cómo quiere que se resuelva su queja?

Queremos saber que piensa usted que sería una resolución justa del problema. Le enviaremos esta información a la 

empresa, junto con su descripción de lo ocurrido, para que entiendan lo que usted busca.

1

2
NÚMERO DE QUEJA

FORMULARIO DE QUEJA SOBRE PRODUCTOS O SERVICIOS FINANCIEROS 2 DE7

¿NECESITA AYUDA CON ESTE FORMULARIO?

(855) 411-CFPB (2372)

Basándose en lo 

que usted sabe 

en este momento, 

calcule el monto 

en dólares de lo 

perdido.

OPCIONAL

¿De qué se trata 

esta queja?

ESCOJA UNO

Cuéntenos en pocas 

palabras cuál fue el 

problema con este 

producto o servicio.

CUENTA O SERVICIO BANCARIO

TARJETA DE CRÉDITO

INFORME DE CRÉDITO

TRANSFERENCIA DE DINERO

HIPOTECA

PRÉSTAMO DE AVANCE DE PAGO

TARJETA PREPAGADA

PRÉSTAMO ESTUDIANTIL

PRÉSTAMO O ARRENDAMIENTO 

VEHICULAR

OTRO PRÉSTAMO DE CONSUMO

OTRO SERVICIO FINANCIERO

3

4

Tipo de producto o servicio

¿Cuándo ocurrió MM DD AAAA

esto?

OPCIONAL

¿Ha tratado 

de resolver 

el problema 

tomando alguna 

de las siguientes 

medidas?

OPCIONAL

COMUNICARSE 

DIRECTAMENTE CON LA 

EMPRESA

COMUNICARSE CON OTRA 

AGENCIA 

DEL GOBIERNO

INICIAR ACCIONES LEGALES

COMUNICARSE CON LA 

OFICINA PARA LA PROTECCIÓN 

FINANCIERA DEL CONSUMIDOR

CONTRATAR UN ABOGADO OTRO

$

Incluya detalles como, por ejemplo, los nombres e información de contacto de los organismos 

gubernamentales con los que se comunicó, las fechas en que se comunicó con ellos, los números 

de caso, el estado de tramitación de los casos, la información de contacto del abogado (si 

corresponde), etc.

5

6

7
NÚMERO DE QUEJA

FORMULARIO DE QUEJA SOBRE PRODUCTOS O SERVICIOS FINANCIEROS 3 DE7

¿NECESITA AYUDA CON ESTE FORMULARIO?

(855) 411-CFPB (2372)

¿Se ha atrasado 

con los pagos 

de su préstamo 

hipotecario o está 

en incumplimiento 

de pago del mismo?

OPCIONAL

Preguntas sobre préstamos hipotecarios (si corresponde)

La presentación de una queja no demorará ni detendrá, de forma automática, la ejecución hipotecaria. 

Si la queja que usted presenta no tiene que ver con un préstamo hipotecario, omita esta página.

¿Le preocupa 

la posibilidad 

de perder su 

propiedad debido 

a la ejecución 

hipotecaria?

OPCIONAL

¿Se ha fijado una 

fecha para la venta 

de su vivienda 

por ejecución 

hipotecaria?

OPCIONAL

¿Le pagó dinero a 

una empresa para 

que le ayudara a 

evitar la ejecución 

hipotecaria?

OPCIONAL

De ser asi, ¿cuál 

es la fecha 

programada para 

la venta de su 

vivienda?

OPCIONAL

También debe marcar “Sí” si la compañía hipotecaria 

considera que usted está en incumplimiento de pago 

o que se ha atrasado con los pagos, incluso si usted 

cree que la compañía está equivocada.

Si ya se ha fijado la fecha para la venta de su vivienda por 

ejecución hipotecaria, puede que usted haya recibido una 

“Notificación de remate” u “Orden judicial de remate”.

Proporcione la fecha exacta, si puede. La 

fecha debe aparecer en la “Notificación 

de remate” u “Orden judicial de remate”.

A este servicio se le denomina a veces “rescate (o 

defensa o prevención) de la ejecución hipotecaria” o 

“mitigación (o control) de pérdidas”.

SÍ

SÍ

SÍ

SÍ

NO

NO

NO

NO SÉ

NO

10a

11

10

9

8

MM DD AAAA
NÚMERO DE QUEJA

FORMULARIO DE QUEJA SOBRE PRODUCTOS O SERVICIOS FINANCIEROS 4 DE7

¿NECESITA AYUDA CON ESTE FORMULARIO?

(855) 411-CFPB (2372)

Datos del titular 

de la cuenta

Número de cuenta

Información de 

contacto de quien 

presenta la queja

Si usted presenta la 

queja en representación de otra persona, 

incluya aquí su propia 

información para que 

podamos informarle 

sobre el estado de tramitación de la queja.

NOMBRE

NOMBRE

APELLIDO(S)

APELLIDO(S)

SUFIJO

SUFIJO

CORREO ELECTRÓNICO

CORREO ELECTRÓNICO

EDAD

TELÉFONO

TELÉFONO

Presento la queja 

en representación: 

MÍA CONTESTE LA PREGUNTA 13, 13A Y 14

DE OTRA PERSONA CONTESTE LAS PREGUNTAS 13, 13A, 14 Y 15

12

13

15

14

CALLE Y NÚMERO

CALLE Y NÚMERO

CIUDAD

CIUDAD

PAÍS

PAÍS

ESTADO

ESTADO

CÓDIGO POSTAL

CÓDIGO POSTAL

Edad del titular 

de la cuenta

OPCIONAL

Datos personales

13a
NÚMERO DE QUEJA

FORMULARIO DE QUEJA SOBRE PRODUCTOS O SERVICIOS FINANCIEROS 5 DE7

¿NECESITA AYUDA CON ESTE FORMULARIO?

(855) 411-CFPB (2372)

Adjuntar 

documentos 

probatorios

OPCIONAL

Adjunte copias de cualquier documento que acredite la queja. La mejor manera en que 

podamos entender su queja es si tenemos la versión completa de documentos como, por 

ejemplo, contratos, cartas, estados de cuenta mensuales y comprobantes de transacciones. 

No incluya el original de los documentos.

Nombre de la 

empresa

Dirección de la 

empresa

OPCIONAL

Teléfono

OPCIONAL

Sitio web

OPCIONAL

Datos de la empresa

16

CALLE Y NÚMERO

CIUDAD ESTADO CÓDIGO POSTAL PAÍS

16a

16b

16c
NÚMERO DE QUEJA

FORMULARIO DE QUEJA SOBRE PRODUCTOS O SERVICIOS FINANCIEROS 6 DE7

¿NECESITA AYUDA CON ESTE FORMULARIO?

(855) 411-CFPB (2372)

EN ACTIVIDAD

DE RESERVA

GUARDIA NACIONAL

EN RETIRO

VETERANO 

(EX COMBATIENTE)

Datos personales 

del integrante 

de las fuerzas 

armadas

OPCIONAL

El titular de la 

cuenta es o era:

OPCIONAL 

(INDIQUE TODOS LOS 

QUE CORRESPONDAN)

Historial de 

servicio militar

OPCIONAL 

(ESCOJA UNA OPCIÓN 

EN CADA COLUMNA)

Hay algunas protecciones a las que se pueden acoger los militares y sus cónyuges y dependientes. 

Si usted no tiene ninguna afiliación militar ni es cónyuge o dependiente de un militar, omita esta página.

INTEGRANTE DE LAS FUERZAS ARMADAS (FF. AA.)

CÓNYUGE / DEPENDIENTE DE UN INTEGRANTE DE LAS FF. AA.

Estado actual Rama Rango

EJÉRCITO

MARINA

INFANTERÍA DE MARINA

FUERZA AÉREA

SERVICIO DE GUARDACOSTAS

SERVICIO DE SALUD PÚBLICA

ADMINISTRACIÓN NACIONAL 

DE OCÉANOS Y ATMÓSFERA

E1 - E4

E5 - E7

E8 - E9

O1 - O3

O4 - O6

O7 - O10

W01 - CW5

CONTESTE LA PREGUNTA 17A

CONTESTE LAS PREGUNTAS 17A Y 17B

NOMBRE APELLIDO(S) SUFIJO

CALLE Y NÚMERO

CIUDAD ESTADO CÓDIGO POSTAL PAÍS

Historial militar (si corresponde)

17

17a

17b
NÚMERO DE QUEJA

FORMULARIO DE QUEJA SOBRE PRODUCTOS O SERVICIOS FINANCIEROS 7 DE7

¿NECESITA AYUDA CON ESTE FORMULARIO?

(855) 411-CFPB (2372)

La información proporcionada es verdadera a mi leal saber y entender. 

Entiendo que la CFPB no puede actuar como mi abogado, un tribunal o un asesor financiero.

Certificación

La información que usted proporcione permitirá a la 

Oficina para la Protección Financiera del Consumidor 

(CFPB) atender su queja o consulta sobre las empresas 

y los servicios que supervisamos. La información sobre 

su queja o consulta (incluidos datos confidenciales) se 

puede poner a disposición de cualquiera de las siguentes partes:

▪	 la empresa que es objeto de su queja;

▪	 terceras partes, según sea necesario con el fin de obtener la información necesaria para atender la queja;

▪	 tribunales, partes litigantes, abogados, entidades 

jurídicas o cortes administrativas, en el curso de un 

proceso judicial o administrativo, o el Departamento 

de Justicia;

▪	 otros organismos o autoridades reguladoras, ya sean 

federales o estatales, para los fines establecidos por 

la ley o para los fines de cumplimiento de la ley, o

▪	 contratantes, agentes y otras partes autorizadas por 

la CFPB para recibir esta información.

Por medio de una base de datos de quejas, también 

podemos poner a disposición del público su queja o 

consulta (salvo los datos confidenciales). 

El presente instrumento de recolección de datos está 

autorizado por la Sección 5493 del Título 12 del Código 

de los Estados Unidos (12 U.S.C. §5493).

No es obligatorio presentar una queja o proporcionar 

datos confidenciales (incluyendo su número de Seguro 

Social). Además, puede retirar su queja en cualquier momento. Sin embargo, si usted no incluye la información 

solicitada, es posible que la CFPB no pueda tomar acción 

en relación a su queja.

Número de control emitido por la Oficina de 

Administración y Presupuesto (OMB): 3170-0011

Utilizamos el presente formulario para recibir las quejas. 

Si usted no desea presentar una queja, no está obligado 

a llenar este formulario. Calculamos que se necesitan 

entre 7 y 10 minutos para llenar el formulario. El número 

de control emitido por la OMB para el formulario es 

3170-0011 y tiene vigencia hasta el 31 de mayo de 2015. 

¿Tiene usted algún comentario o sugerencia? Envíenos 

un mensaje a PRA@cfpb.gov.

Aviso sobre la Ley de Privacidad

Aviso sobre la recolección de información del consumidor
SUBMIT A COMPLAINT ABOUT A FINANCIAL PRODUCT OR SERVICE

Debt Collection

CASE NUMBER

1 OF8

VERSION 3.2 / 2015

Debt was discharged in 

bankruptcy

Debt resulted from 

identity theft

Debt was paid

Debt is not mine

Threatened to arrest me 

or take me to jail if I do 

not pay

Threatened to sue me on 

debt that is too old to be 

sued on

Sued me without properly 

notifying me of lawsuit

Sued me where I did not 

live or did not sign for the 

debt

Collected or attempted 

to collect exempt funds 

(i.e. unemployment, child 

support, etc.)

Seized or attempted to 

seize property

Which of these 

best describes your 

issue?

ENTER THE NUMBER OF 

THE OPTION THAT BEST 

DESCRIBES YOUR ISSUE

Communication tactics

Improper contact or 

sharing of information

Continued attempts to 

collect a debt I do not owe

False statements or 

representation

Disclosure or 

verification of debt

Taking or threatening to 

take an illegal action

Frequent or repeated 

calls

Called outside of 8am9pm

Used obscene, profane or 

other abusive language

Threatened to take legal 

action

Called after sent written 

cease of communication 

notice

Contacted me after I 

asked not to

Contacted my employer 

after I asked not to

Contacted me instead of 

my attorney

Talked to a third party 

about my debt

Attempted to collect 

wrong amount

Impersonated attorney, 

law enforcement or 

government official

Indicated committing 

crime by not paying debt

Indicated should not 

respond to lawsuit

Did not receive notice of 

right to dispute

Not enough information 

to verify debt (i.e. amount 

of debt & name of 

creditor)

Did not disclose 

communication was an 

attempt to collect a debt

3A

4A 6A

6D

1A

2A

5A

3B

4B

6B

6E

1B

2B

5B

3C

4C

6C

6F

4D

1C

2C

5C

1D 2D

5D

1E

2

CREDIT CARD

MORTGAGE

AUTO

MEDICAL

FEDERAL STUDENT LOAN

NON-FEDERAL STUDENT LOAN

OTHER (I.E., PHONE, HEALTH 

CLUB, ETC.)

I DON’T KNOW

What type of debt 

is this?

CHOOSE ONE

What is this complaint about?

1

OPTION NUMBER

If someone is 

contacting you 

by phone, what 

number are they 

calling?

OPTIONAL

3 PHONE NUMBER
CASE NUMBER

SUBMIT A DEBT COLLECTION COMPLAINT

VERSION 3.2 / 2015

2 OF8

We want to know what happened. Providing facts and details like dates and where transactions occurred helps us 

understand your complaint. For example, did someone call you? Did you visit a company in person?

Describe what 

happened so we 

can understand the 

issue

Do not include 

sensitive information 

like your name, contact 

information, account 

number, or Social 

Security Number in this 

field. We will collect 

certain personal 

information at a later 

step.

What do you think 

would be a fair 

resolution to your 

issue?

Do not include 

sensitive information 

like your name, contact 

information, account 

number, or Social 

Security Number in this 

field.

What happened?

Desired Resolution

We want to understand what you think would be a fair resolution to this issue. We’ll forward this information to the 

company along with your description of what happened so that all parties know what you are looking for.

4

5
CASE NUMBER

SUBMIT A DEBT COLLECTION COMPLAINT

VERSION 3.2 / 2015

3 OF8

We want to know as much as you can tell us about the company collecting the debt. Even if you don’t know the company’s name, provide any phone numbers for the company, a representative name, or an account number and we’ll 

try to match things up on our end.

Attach any 

supporting 

documents

Here we’re asking for copies of any documents about your complaint. Documents like 

contracts, letters, monthly statements, and transaction receipts can help us better understand 

your complaint.

Debt collection 

company name

Who’s contacting you about this debt?

Company contact 

information

OPTIONAL

Even if you don’t 

know the company’s 

name, please try 

your best to provide 

any phone numbers 

for the company, a 

representative name, 

or an account number 

and we’ll try to match 

things up on our end.

REPRESENTATIVE NAME OR ID

ACCOUNT NUMBER

PHONE NUMBER

STREET

CITY STATE ZIP CODE COUNTRY

6

6a

I DON’T KNOW THE 

DEBT COLLECTION 

COMPANY NAME
CASE NUMBER

SUBMIT A DEBT COLLECTION COMPLAINT

VERSION 3.2 / 2015

4 OF8

Company name

Do you know 

where this debt 

came from?

OPTIONAL,

CHOOSE ONE

Do you know where this debt came from?

We want to know if the company contacting you was hired by a different company to collect on a debt. If the debt is 

with a different company, we’ll give you the option to submit two complaints about your issue: one complaint about 

the debt collector and a second complaint about the company that owns the debt.

If you don’t know where the debt came from, choose “I don’t know.”

Company contact 

information

Even if you don’t 

know the company’s 

name, please try 

your best to provide 

any phone numbers 

for the company, a 

representative name, 

or an account number 

and we’ll try to match 

things up on our end.

Submit a separate 

complaint against 

this company?

ACCOUNT NUMBER

By selecting yes, we will create a separate complaint against this 

company. This will be in addition to your complaint against the debt 

collection company.

SAME COMPANY

YES

DIFFERENT COMPANY

NO

I DON’T KNOW

FILL OUT QUESTIONS 8 & 9

CONTINUE TO QUESTION 10

CONTINUE TO QUESTION 10

8a

9

8

7

REPRESENTATIVE NAME OR ID PHONE NUMBER

STREET

CITY STATE ZIP CODE COUNTRY

I DON’T KNOW THE 

COMPANY NAME
CASE NUMBER

SUBMIT A DEBT COLLECTION COMPLAINT

VERSION 3.2 / 2015

5 OF8

The company needs your full name and the last four digits of your Social Security Number to match your complaint to 

their records and respond to your complaint.

Consumer’s 

identification 

information

We’ll use this 

information to contact 

you about the status of 

your complaint.

Contact 

information of 

person submitting 

complaint

FIRST NAME

FIRST NAME

LAST NAME

LAST NAME

LAST FOUR DIGITS OF SOCIAL SECURITY NUMBER

SUFFIX

SUFFIX

AGE

Companies match this information to their records to respond to your 

complaint. Not providing may delay or prevent the company from 

responding to your complaint.

EMAIL PHONE NUMBER

PHONE NUMBER

Are you filing on 

behalf of someone 

else?

YES, I AM FILING ON BEHALF OF SOMEONE ELSE FILL OUT QUESTIONS 11 & 12

NO, I AM FILING ON BEHALF OF MYSELF FILL OUT QUESTION 11

10

11

12

STREET

STREET

CITY

CITY

COUNTRY

COUNTRY

STATE

STATE

ZIP CODE

ZIP CODE

Additional 

identification

OPTIONAL

11a

Personal information
CASE NUMBER

SUBMIT A DEBT COLLECTION COMPLAINT

VERSION 3.2 / 2015

6 OF8

ACTIVE

RESERVE

NATIONAL GUARD

RETIRED

VETERAN

Servicemember 

personal 

information

The consumer is 

now or was:

OPTIONAL,

CHECK ALL THAT APPLY

Service details

CHOOSE ONE 

IN EACH COLUMN

There are certain protections that apply to servicemembers and their spouses and dependents.

A SERVICEMEMBER

THE SPOUSE / DEPENDENT OF A SERVICEMEMBER

Current status Branch Rank

ARMY

NAVY

MARINES

AIR FORCE

COAST GUARD

PUBLIC HEALTH SERVICE

NATIONAL OCEANIC & 

ATMOSPHERIC ADMIN

E1 - E4

E5 - E7

E8 - E9

O1 - O3

O4 - O6

O7 - O10

W01 - CW5

FILL OUT QUESTION 13A

FILL OUT QUESTIONS 13A & 13B

FIRST NAME LAST NAME SUFFIX

STREET

CITY STATE ZIP CODE COUNTRY

Military affiliation

13

13a

13b
CASE NUMBER

SUBMIT A DEBT COLLECTION COMPLAINT

VERSION 3.2 / 2015

7 OF8

The information given is true to the best of my knowledge and belief. 

I understand that the CFPB cannot act as my lawyer, a court of law or a financial advisor.

SIGNATURE DATE

Authorization

Ways to submit this form

Other ways to submit your complaint

Online

consumerfinance.gov/complaint

Over the phone

(855) 411-2372

By mail

Consumer Financial Protection Bureau

PO Box 4503, Iowa City, IA 52244

By fax

(855) 237-2392
CASE NUMBER

SUBMIT A DEBT COLLECTION COMPLAINT

VERSION 3.2 / 2015

8 OF8

The information you provide will permit the Consumer 

Financial Protection Bureau to respond to your complaint 

or inquiry about companies and services we supervise. 

Information about your complaint or inquiry (including 

your personally identifiable information) may be shared:

▪	 with the entity that is the subject of your complaint;

▪	 with third parties as necessary to get information 

relevant to resolving a complaint;

▪	 with a court, a part in litigation, a magistrate, an adjudicative body or administrative tribunal in the course 

of a proceeding or the Department of Justice;

▪	 with other federal or state agencies or regulatory 

authorities for enforcement and statutory purposes; 

and

▪	 with contractors, agents, and others authorized by 

the CFPB to receive this information.

We may also share your complaint or inquiry (but not 

your personally identifiable information) with the public 

through a public complaint database. 

This collection of information is authorized by 12 U.S.C. § 

5493.

You are not required to file a complaint or share any identifying information, including your social security number, 

and you may withdraw your complaint at any time. However, if you do not include the requested information, the 

CFPB may not be able to act on your complaint.

OMB Control Number 3170-0011

This is how we accept complaints. You’re not required to 

fill out this form if you don’t want to submit a complaint. 

We estimate that it takes about 7 to 10 minutes to finish 

completing the form. Our OMB control number for this 

form is 3170-0011 and expires on 5/31/2015. Comments 

or suggestions? Email us at PRA@cfpb.gov.

Privacy Act Statement

Notice of Consumer Information Collection
FORMULARIO DE QUEJA SOBRE PRODUCTOS O SERVICIOS FINANCIEROS

Cobro de deudas

NÚMERO DE CASO

1 DE8

VERSIÓN 3.0 / 2013

La deuda fue eliminada 

por quiebra

La deuda es el resultado 

del robo de identidad

La deuda fue saldada

La deuda no es mía

Amenazaron con arrestarme 

o llevarme a la cárcel si no 

pago la deuda

Amenazaron con 

demandarme por una 

deuda que está exenta 

por su antigüedad

Me demandaron sin darme 

la debida notificación

Me demandaron en un lugar 

donde no residí o donde no 

contraje la deuda

Embargaron o intentaron 

embargar ingresos que 

están exentos para efectos 

del cobro de la deuda 

(seguro de desempleo, 

pensión para los hijos, etc.)

Tomaron posesión de 

bienes o intentaron hacerlo

¿Cuál de las 

siguientes 

opciones mejor 

describe su 

problema?

ESCRIBA EL NÚMERO DE 

LA OPCIÓN QUE MEJOR 

DESCRIBA SU PROBLEMA

Tácticas de comunicación

Comunicación 

inoportuna o cesión 

indebida de datos

Intentos repetidos de 

cobrar deudas que no me 

corresponden

Falsa declaración o 

representación

Omisión de información 

obligatoria o de la 

verificación de la deuda

Amenazas o iniciación de 

medidas ilegales

Llaman frecuentemente 

o repetidamente

Llaman antes de las 8am 

o después de las 9pm

Usan lenguaje soez, 

ofensivo o insultante

Amenazan con acción 

legal

Siguen llamando tras 

recibir por escrito 

que suspendan 

comunicaciones

No hicieron caso a mi 

petición de que no se 

comunicaran conmigo

No hicieron caso a mi 

petición de que no se 

comunicaran con mi 

empleador

Se comunicaron conmigo 

y no con mi abogado

Hablaron con terceros 

sobre mi deuda

Intentaron cobrar un 

monto indebido

Se hicieron pasar 

por abogados o por 

funcionarios del orden 

público o del Gobierno

Indicaron que violé la ley 

al no pagar la deuda

Indicaron que no debo 

responder a la demanda

No me informaron sobre 

mi derecho a impugnar la 

validez de la deuda

No hay información 

suficiente para verificar 

la validez de la deuda (el 

monto y el acreedor)

No me informaron que 

era un intento de cobrar 

una deuda

3A

4A 6A

6D

1A

2A

5A

3B

4B

6B

6E

1B

2B

5B

3C

4C

6C

6F

4D

1C

2C

5C

1D

2D

5D

1E

2

TARJETA DE CRÉDITO

PRÉSTAMO HIPOTECARIO

AUTOMÓVIL

CUENTAS MÉDICAS

PRÉSTAMO ESTUDIANTIL FEDERAL

PRÉSTAMO ESTUDIANTIL PRIVADO

OTRO (TELÉFONO, 

GIMNASIO, ETC.)

NO SÉ

¿Qué tipo de 

deuda es?

ESCOJA UNO

¿De qué se trata esta queja?

1

NÚMERO DE OPCIÓN

Si alguien se está 

comunicando con 

usted por teléfono, 

¿a qué número 

está llamando?

OPCIONAL

3 TELÉFONO
NÚMERO DE CASO

FORMULARIO DE QUEJA SOBRE EL COBRO DE DEUDAS

VERSIÓN 3.0 / 2013

2 DE8

Queremos saber lo que sucedió. Si usted nos proporciona los detalles de lo ocurrido —como las fechas y lugares de 

las transacciones—entonces podremos entender mejor su queja. Por ejemplo: ¿Alguien le llamó por teléfono? ¿Usted 

visitó la empresa en persona?

Describa lo que 

pasó, para que 

podamos entender 

el problema.

No incluya aquí sus 

datos confidenciales, 

como su nombre y 

apellido, información 

de contacto, número 

de cuenta o número 

de Seguro Social. Le 

pediremos algunos de 

estos datos en un paso 

posterior.

¿Qué piensa usted 

que sería una 

resolución justa del 

problema?

No incluya aquí sus 

datos confidenciales, 

como su nombre y 

apellido, información 

de contacto, número 

de cuenta o número de 

Seguro Social.

¿Qué pasó?

¿Cómo quiere que se resuelva su queja?

Queremos saber que piensa usted que sería una resolución justa del problema. Le enviaremos esta información a la 

empresa, junto con su descripción de lo ocurrido, para que entiendan lo que usted busca.

4

5
NÚMERO DE CASO

FORMULARIO DE QUEJA SOBRE EL COBRO DE DEUDAS

VERSIÓN 3.0 / 2013

3 DE8

Queremos saber tanto como usted nos pueda decir sobre la empresa que intenta cobrar la deuda. Aunque no sepa 

el nombre de la empresa, trate de proporcionar algún número de teléfono para la misma, el nombre de alguno de 

sus representantes o un número de cuenta. Por nuestra parte, haremos todo lo posible para localizar la empresa.

Adjuntar 

documentos 

probatorios

OPCIONAL

Adjunte copias de cualquier documento que acredite la queja. La mejor manera en que 

podamos entender su queja es si tenemos la versión completa de documentos como, por 

ejemplo, contratos, cartas, estados de cuenta mensuales y comprobantes de transacciones. 

No incluya el original de los documentos.

Nombre de la 

empresa de cobro 

de deudas

¿Quién se ha comunicado con usted respecto a esta deuda?

Información de 

contacto de la 

empresa de cobro 

de deudas

OPCIONAL

Aunque no sepa el 

nombre de la empresa, 

trate de proporcionar 

algún número de 

teléfono para la misma, 

el nombre de alguno 

de sus representantes 

o un número de 

cuenta. Por nuestra 

parte, haremos todo lo 

posible para localizar 

la empresa.

NOMBRE O IDENTIFICACIÓN DEL REPRESENTANTE

NÚMERO DE CUENTA

TELÉFONO

CALLE Y NÚMERO

CIUDAD ESTADO CÓDIGO POSTAL PAÍS

6

6a

NO SÉ EL NOMBRE 

DE LA EMPRESA
NÚMERO DE CASO

FORMULARIO DE QUEJA SOBRE EL COBRO DE DEUDAS

VERSIÓN 3.0 / 2013

4 DE8

Nombre de la 

empresa acreedora

¿Sabe quien es el 

acreedor de esta 

deuda?

OPCIONAL 

¿Quien es el acreedor de esta deuda?

Queremos saber si la empresa que se puso en contacto con usted fue contratada por otra empresa para cobrar la 

deuda. Si esta otra empresa es el acreedor de la deuda, le daremos a usted la oportunidad de presentar dos quejas: 

una contra la empresa de cobro de deudas y otra contra la empresa acreedora.

Si usted no sabe quien es el acreedor de la deuda, elija “No sé”.

Información de 

contacto de la 

empresa acreedora

Aunque no sepa el 

nombre de la empresa, 

trate de proporcionar 

algún número de 

teléfono para la misma, 

el nombre de alguno 

de sus representantes 

o un número de 

cuenta. Por nuestra 

parte, haremos todo lo 

posible para localizar 

la empresa.

¿Desea presentar 

por separado 

una queja contra 

la empresa 

acreedora?

NÚMERO DE CUENTA

Si usted elije “Sí”, iniciaremos por separado la gestión de una queja 

contra la empresa acreedora. Como resultado, se dará trámite a dos 

quejas en total: una contra la empresa de cobro de deudas y otra 

contra la empresa acreedora.

LA MISMA EMPRESA QUE COBRA LA DEUDA

SÍ

OTRA EMPRESA ACREEDORA

NO

NO SÉ

CONTESTE LAS PREGUNTAS 8 Y 9

PASE A LA PREGUNTA 10

PASE A LA PREGUNTA 10

8a

9

8

7

NOMBRE O IDENTIFICACIÓN DEL REPRESENTANTE TELÉFONO

CALLE Y NÚMERO

CIUDAD ESTADO CÓDIGO POSTAL PAÍS

NO SÉ EL NOMBRE 

DE LA EMPRESA
NÚMERO DE CASO

FORMULARIO DE QUEJA SOBRE EL COBRO DE DEUDAS

VERSIÓN 3.0 / 2013

5 DE8

Usted debe proporcionar su nombre completo y los cuatro últimos dígitos de su número de Seguro Social para que la 

empresa pueda encontrar su expediente y responder a su queja.

Datos de 

información 

de contacto

Vamos a usar estos 

datos para informarle 

sobre el estado de 

tramitación de su 

queja.

Otro contacto

OPCIONAL

Utilice esta sección 

si desea que le 

informemos a otra 

persona sobre el 

estado de tramitación 

de la queja.

NOMBRE

NOMBRE

APELLIDO(S)

APELLIDO(S)

CUATRO ÚLTIMOS DÍGITOS DE SU NÚMERO DE SEGURO SOCIAL

SUFIJO

SUFIJO

EDAD

Las empresas utilizan esta información para encontrar en sus registros 

el expediente del cliente y responder a las quejas. La omisión de estos 

datos puede demorar o imposibilitar la respuesta de la empresa.

CORREO ELECTRÓNICO TELÉFONO

TELÉFONO

10

11

CALLE Y NÚMERO

CALLE Y NÚMERO

CIUDAD

CIUDAD

PAÍS

PAÍS

ESTADO

ESTADO

CÓDIGO POSTAL

CÓDIGO POSTAL

Otros datos de 

identificación

OPCIONAL

10a

Datos personales
NÚMERO DE CASO

FORMULARIO DE QUEJA SOBRE EL COBRO DE DEUDAS

VERSIÓN 3.0 / 2013

6 DE8

ACTIVO

RESERVA

GUARDIA NACIONAL

EN RETIRO

VETERANO 

(EX COMBATIENTE)

Datos personales 

del integrante 

de las fuerzas 

armadas

El consumidor es 

o era:

OPCIONAL 

(INDIQUE TODOS LOS 

QUE CORRESPONDAN)

Historial de 

servicio militar

ESCOJA UNA OPCIÓN 

EN CADA COLUMNA

Hay algunas protecciones a las que se pueden acoger los militares y sus cónyuges y dependientes.

INTEGRANTE DE LAS FUERZAS ARMADAS (FF. AA.)

CÓNYUGE / DEPENDIENTE DE UN INTEGRANTE DE LAS FF. AA.

Estado actual Rama Rango

EJÉRCITO

MARINA

INFANTERÍA DE MARINA

FUERZA AÉREA

SERVICIO DE GUARDACOSTAS

SERVICIO DE SALUD PÚBLICA

ADMINISTRACIÓN NACIONAL 

DE OCÉANOS Y ATMÓSFERA 

E1 - E4

E5 - E7

E8 - E9

O1 - O3

O4 - O6

O7 - O10

W01 - CW5

CONTESTE LA PREGUNTA 12A

CONTESTE LAS PREGUNTAS 12A Y 12B

NOMBRE APELLIDO(S) SUFIJO

CALLE Y NÚMERO

CIUDAD ESTADO CÓDIGO POSTAL PAÍS

Historial militar

12

12a

12b
NÚMERO DE CASO

FORMULARIO DE QUEJA SOBRE EL COBRO DE DEUDAS

VERSIÓN 3.0 / 2013

7 DE8

La información proporcionada es verdadera a mi leal saber y entender. 

Entiendo que la CFPB no puede actuar como mi abogado, un tribunal o un asesor financiero.

FIRMA FECHA

Certificación

Maneras de presentar este formulario

Otras maneras de presentar su queja

Por Internet

consumerfinance.gov/complaint

Por teléfono

(855) 411-2372

Por correo

Oficina para la Protección Financiera Del Consumidor

PO Box 4503, Iowa City, IA 52244

Por fax

(855) 237-2392
NÚMERO DE CASO

FORMULARIO DE QUEJA SOBRE EL COBRO DE DEUDAS

VERSIÓN 3.0 / 2013

8 DE8

La información que usted proporcione permitirá a la 

Oficina para la Protección Financiera del Consumidor 

(CFPB) atender su queja o consulta sobre las empresas 

y los servicios que supervisamos. La información sobre 

su queja o consulta (incluidos datos confidenciales) se 

puede poner a disposición de cualquiera de las siguentes partes:

▪	 la empresa que es objeto de su queja;

▪	 terceras partes, según sea necesario con el fin de 

obtener la información necesaria para atender la 

queja;

▪	 tribunales, partes litigantes, abogados, entidades 

jurídicas o cortes administrativas, en el curso de un 

proceso judicial o administrativo, o el Departamento 

de Justicia;

▪	 otros organismos o autoridades reguladoras, ya sean 

federales o estatales, para los fines establecidos por 

la ley o para los fines de cumplimiento de la ley, o

▪	 contratantes, agentes y otras partes autorizadas por 

la CFPB para recibir esta información.

Por medio de una base de datos de quejas, también 

podemos poner a disposición del público su queja o 

consulta (salvo los datos confidenciales). 

El presente instrumento de recolección de datos está 

autorizado por la Sección 5493 del Título 12 del Código 

de los Estados Unidos (12 U.S.C. §5493).

No es obligatorio presentar una queja o proporcionar 

datos confidenciales (incluyendo su número de Seguro 

Social). Además, puede retirar su queja en cualquier 

momento. Sin embargo, si usted no incluye la información solicitada, es posible que la CFPB no pueda tomar 

acción en relación a su queja.

Número de control emitido por la Oficina de 

Administración y Presupuesto (OMB): 3170-0011

Utilizamos el presente formulario para recibir las quejas. 

Si usted no desea presentar una queja, no está obligado 

a llenar este formulario. Calculamos que se necesitan 

entre 7 y 10 minutos para llenar el formulario. El número 

de control emitido por la OMB para el formulario es 

3170-0011 y tiene vigencia hasta el 30 de noviembre 

del 2014. ¿Tiene usted algún comentario o sugerencia? 

Envíenos un mensaje a PRA@cfpb.gov.

Aviso sobre la Ley de Privacidad

Aviso sobre la recolección de información del consumidor
CONSUMER RESPONSE CENTER

AGENT CALL SCRIPTS

Version 5.01 (Presented in script # order) 

 March 1, 2015 
Agent Scripts March 1, 2015 V5.01 

Script # Script Text Comments/Notes 

i1 Good <time of day>! Thank you for calling the Consumer Financial Protection Bureau.

Does record auto-populate from IVR?

<Select YES or NO> button

Note: Script page number NOT 

visible.

i2 {If Caller punched in case number on phone and the case auto populates.}

Can you confirm that you are calling about a case number ending in “xxxx”? 

Use the last 4 digits of the case number for verification.

Verify the caller: I need to ask a couple of questions to verify your identity. 

- What is your name? Confirm contact or complainant's name.

- Can you verify the address, including zip code and email address? 

<Go to Closing> button

<Beginning> button

i2

i3 Closing for existing cases}

If Zip code has not been provided:

If you don’t mind, can I get your Zip code for tracking purposes?

Zip Code <Fill in Zip Code>

Thank you for calling the Consumer Financial Protection Bureau. You can also find more information at 

consumerfinance.gov. 

<Beginning> button

<Previous> button

i3

i4 {If the case does not auto populate.}

Are you calling in reference to a complaint you already have on file?* 

<Select YES or NO> button

If the caller speaks Spanish transfer to 330002. 
Agent Scripts March 1, 2015 V5.01 

Script # Script Text Comments/Notes 

<Beginning> button

i4

i5 {If case does not auto populate AND caller says case is on file}

Verify the caller: I need to ask a couple of questions to verify your identity. 

- Can you provide the case number?

- What is your name? Conduct Search and then confirm contact or complainant’s name.

- Can you verify the address, including Zip code and email address? 

- If no address: What is the email address provided for the case?

<Go to Closing> button

<Beginning> button

i5

02 To get started is there a phone number where I can reach you if we get disconnected?

 <Fill in phone number> 

What product or service can I help you with today?

HT: Don’t forget to CONFIRM THE PURPOSE OF THE CALL as soon as callers tell you their issue or 

reason for the call.

High Level Product* <Fill in HL Product from drop down box>

{Dynamic, if High Level Product = Payday loan}

Does this concern debt collection of a payday loan?*

<click on YES or NO button>

{if YES is selected, the following helper text will display}

NOTE: if “Yes” is selected, the product will be changed to “Debt collection” with sub-product “Payday 

loan”

 

{Dynamic, if Product /sub-product = Other financial service/debt settlement} 

Does this concern a problem with a debt collector?*

<click on YES or NO button>

{Dynamic, if Product /sub-product = Other financial service/credit repair}

Does this concern a problem with your credit report or score?*

<click on YES or NO button>

 

 

 

 

 

 

 

 

 

 

Default Value 

“Does this concern ... payday 

loan?*” = NO

 

Default Value 

“Does this concern..debt 

collector?*” = NO

 

 

Default Value 

“Does this concern..credit 

report?*” = NO

 

 

 

 
Agent Scripts March 1, 2015 V5.01 

Script # Script Text Comments/Notes 

< PRODUCT SELECTION HINTS (Click here) > button

{Dynamic, if agent clicks to open Product selection hints}

1) Bank account or service for checking and savings accounts, debit cards, CDs, cashing a check without 

an account or other bank services.

2) Credit card 

3) Consumer loan for vehicle loans and leases, installment loans (e.g. medical, appliance, vacation, 

funeral), title loans, pawn loans or a personal line of credit.

4) Credit reporting for incorrect information on a credit report, problems with a credit reporting company's 

investigation, improper use of a credit report, inability to obtain a credit report, credit monitoring or identity 

protection services.

5) Debt collection for problems related to attempts to contact you by a collection company regarding debt 

owed, or alleged to be owed.

6) Money transfers for transfers of money within the U.S. and internationally.

7) Mortgage for mortgages, second mortgages, home equity lines of credit, reverse mortgage, etc.

8) Non-product inquiry for any question that is not about one of the products listed above.

9) Other financial service for non-bank check cashing services, credit repair (EXCEPT for problems with a 

credit report}, debt settlement (EXCEPT for a problem with a debt collector), foreign currency exchange, 

money orders, refund anticipation checks and traveler’s or cashier’s checks. 

10) Payday loan for all problems related to payday loans, EXCEPT those concerning lender collection 

practices on a payday loan, which should be identified as a “Debt collection” complaint

11) Prepaid card for general reloadable prepaid cards, government benefit payment cards (e.g 

unemployment, social security), EBT cards (e.g. WIC,TANF,SNAP), ID prepaid cards (e.g. students), 

transit cards, gift or merchant cards, mobile wallets, payroll cards, and other special purpose cards.

12) Student loan for Federal (Stafford, Direct, Consolidation, PLUS, Perkins), Non-federal (e.g. private, 

alternative, or other student loan).

HT: If the caller is asking about a product not mentioned above, go to and follow Answer 1836. 

Afterwards, click “Go to closing” and select the product/sub-product that best fits the topic.

If the caller is speaking Spanish or has been transferred to a Spanish speaking agent:

Could you confirm that you would like to receive written communication from us in Spanish?* (If Yes, 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Default value: 

Language Preference: ENGLISH
Agent Scripts March 1, 2015 V5.01 

Script # Script Text Comments/Notes 

Select Spanish.) <Select English (US) or Spanish>

<Go to Closing> button 

Use the “Go to Closing” button on this screen only if you are saving a partial case, i.e. a call was disconnected part 

way through taking a complaint.

<Previous> button

<Next> button

2

03 Thank you. I’ll be happy to help you. 

Choose “Question” or “Complaint” based on information provided. If you are uncertain ask consumer.

Do you want to file a complaint or do you need help with a question?*

 <Select Question or Complaint> button

<Beginning> button

<Previous> button

<Next> button

3

04 Deleted

05 Deleted

6

[standard 

script page]

{If caller has a Question}

If the consumer has not already provided their question, say:

I would be more than happy to research your inquiry to try and provide you an answer.

What specific question did you have?

Search the Knowledgebase using keywords.

If the answer is not readily available in the Knowledgebase, check the Consumer Action Handbook. If 

product falls outside CFPB scope, refer to Knowledgebase 1836. 

 

OR 

Go to consumerfinance.gov/askcfpb and search for an answer.

If information is in CFPB scope and still not found: 

Unfortunately, I can't find any information about your specific question. To request that your question be 
Agent Scripts March 1, 2015 V5.01 

Script # Script Text Comments/Notes 

added to our database of FAQs about financial issues, visit on our website at 

consumerfinance.gov/askcfpb. Ask CFPB is an interactive online tool for helping consumers find clear 

unbiased answers to financial questions. If you select the option to have us contact you by email, we’ll let 

you know if your question is answered and added to Ask CFPB. You also always have the option to 

continue with a complaint if desired. HT: CFPB Phone # : 1 (855) 411-CFPB (2372) 

Would you like to continue with either of these?

If consumers choose to submit their questions, offer to guide them to the Add a New Question 

button on our website.

(Agents may also offer to submit it online or through our Propose button for consumers if 

requested.

If consumers wish to submit complaints, click “Click if consumer wants to file complaint” button. 

If consumers say no, click “Go to closing” button.

<Go to Closing> button

<Click if Consumer wants to file Complaint> button

<Beginning> button

<Previous> button

6

6

[2015 

customer 

service 

survey 

page – 

temporary 

language 

highlighted]

{If caller has a Question}

If the consumer has not already provided their question, say:

I would be more than happy to research your inquiry to try and provide you an answer. Also, at the end 

you’ll have a chance to take a short survey to help us improve this service. Now, what specific question 

did you have?

Search the Knowledgebase using keywords.

If the answer is not readily available in the Knowledgebase, check the Consumer Action Handbook. If 

product falls outside CFPB scope, refer to Knowledgebase 1836. 

 

OR 

Go to consumerfinance.gov/askcfpb and search for an answer.

If information is in CFPB scope and still not found: 

Unfortunately, I can't find any information about your specific question. To request that your question be 

added to our database of FAQs about financial issues, visit on our website at 

consumerfinance.gov/askcfpb. Ask CFPB is an interactive online tool for helping consumers find clear 

unbiased answers to financial questions. If you select the option to have us contact you by email, we’ll let 

you know if your question is answered and added to Ask CFPB. You also always have the option to 
Agent Scripts March 1, 2015 V5.01 

Script # Script Text Comments/Notes 

continue with a complaint if desired. HT: CFPB Phone # : 1 (855) 411-CFPB (2372) 

Would you like to continue with either of these?

If consumers choose to submit their questions, offer to guide them to the Add a New Question 

button on our website.

(Agents may also offer to submit it online or through our Propose button for consumers if 

requested.

If consumers wish to submit complaints, click “Click if consumer wants to file complaint” button. 

If consumers say no, click “Go to closing” button.

<Go to Closing> button

<Click if Consumer wants to file Complaint> button

<Beginning> button

<Previous> button

6

07 {If HL product is Credit Card}

To best assist you, I need to ask you a few questions.

Does your card say “debit” or “check card” on the front of it?

< Select YES or NO>

7

08 {If product says Debit/Check card}

Since your card says [debit/check] card, is it associated with your checking account or your savings 

account?

Select Product*. 

<Select HL Product or HL and Sub-Product from drop down>

8

09 DELETED

9 

April 2014: Deactivated Script 

10 DELETED

 

10

April 2014: Deactivated Script 

11 DELETED April 2014: Deactivated Script 
Agent Scripts March 1, 2015 V5.01 

Script # Script Text Comments/Notes 

11 

12 DELETED

12

April 2014: Deactivated Script 

13 DELETED

13

April 2014: Deactivated Script 

14 DELETED

14

April 2014: Deactivated Script 

15 DELETED

15

16 DELETED

16

April 2014: Deactivated Script 

17 DELETED

17

April 2014: Deactivated Script 

18 If consumer has NOT identified the type of student loan, then say: “Are you calling in regards to a federal 

or non-federal student loan?"

 ___ Federal (Say: “FFEL, Stafford, Direct, Consolidation, PLUS, Grad PLUS, NDSL Perkins”)

 __ Non-Federal (Say: “Private, Alternative, Other Student Loan:)

 __ Consumer is not sure

<Beginning> button

<Previous> button

18

19 {If caller has a Federal Student loan}

Currently the CFPB is only receiving complaints for non-Federal student loans. Since your loan is a 

federal loan, the Department of Education will be able to further assist you.

Provide the contact information for the Department of Education and then cold transfer. 
Agent Scripts March 1, 2015 V5.01 

Script # Script Text Comments/Notes 

Department of Education Federal Student Aid Ombudsman:

http://studentaid.ed.gov 

1 (877) 557-2575

Before you file a complaint you may want to click on Repay Your Loans found in the top menu for 

information about locating your servicers, learning more about payment, deferment and forbearance 

options or help with disputes.

Thank you for contacting the Consumer Financial Protection Bureau, there is more information about 

financial products on our website consumerrfinance.gov. May I place you on a brief hold while I connect 

you? 

19

20 {If caller is not sure if their loan is private or federal}

Currently the CFPB is only receiving complaints for non-federal student loans. 

To check whether your student loan is federal or non-federal, I can transfer you to the Department of 

Education or refer you to the National Student Loan Data System for Students website.

Phone: 1 (800) 4-FED-AID (1 (800) 433-3243)

Website: https://www.nslds.ed.gov

Once you are on the NSLDS website, select “Financial Aid Review” for a list of all federal loans made to 

you.

Click 'Accept' twice and then you will be prompted to enter personal information.

Check each individual loan to see who the servicer is for that loan (this is the company that collects 

payments from you). 

A few helpful tips for federal and non-federal loans: 

Federal loans: 

• Probably have a name like Stafford, PLUS, Direct, or Perkins 

Non-federal loans: 

• Issued by a bank, credit union, your school, or other lending institution 

• Might use names like “private” or “alternative” 

• Issued by a non-profit or state agency 

• If you’re not sure whether you have non-federal loans, contact your school’s financial aid office since 

they may have this information on file. 
Agent Scripts March 1, 2015 V5.01 

Script # Script Text Comments/Notes 

20

21 {If caller is filing a Credit reporting complaint}

Which of these best describes your issue?* {Dropdown list with issues and sub issues}

• Incorrect Information on Credit Report

o Information is not mine

o Account terms

o Account status

o Personal information

o Public Record

o Reinserted previously deleted information

• Credit reporting company’s investigation 

o Investigation took too long

o No notice of investigation status/result

o Inadequate help over the phone

o Problem with statement of dispute

• Improper use of my credit report

o Report improperly shared by CRA

o Received marketing offer after opting out

o Report shared with employer without consent

• Unable to get credit report/score

o Problem getting my free annual report

o Problem getting report or score

o Credit monitoring or identity protection

• Problem cancelling or closing account

o Billing dispute

o Receiving unwanted marketing /advertising

o Account terms and changes

o Problems with fraud alerts

21

SCRIPT DE ACTIVATED AS

PART OF THE DEBT 

COLLECTION RELEASE (July 

2013)

22 {For HL Product = Credit Reporting only}

May I have the name of the company you are calling about? {Dropdown list with Companies} 

• Equifax

• Experian

• TransUnion

• Certegy Check Services

• Chex Services

• CoreLogic Teletrack

SCRIPT DE ACTIVATED AS 

PART OF THE DEBT 

COLLECTION RELEASE (July 

2013)
Agent Scripts March 1, 2015 V5.01 

Script # Script Text Comments/Notes 

• CoreScore Credit Report

• DataX

• Factor Trust

• ID Analytics

• Innovis

• L2C\Microbilt

• PRBC / MicroBilt

• TeleCheck

• Other

{If the caller says the company is not on the list and the Agent selected Other in the preceding drop down}

If Other, company name (as stated by Consumer)* 

<Fill in Company>

Address(1) <Fill in Street Address, optional>

Address(2) <Fill in Street/other address, optional>

City <fill in City, optional> 

State <Fill in from Drop Down List, optional>

Zip Code <Fill in zip +4, optional>

Telephone <fill in phone #, optional>

Website <fill in web site, optional>

Did you file a dispute about the issue with the credit reporting company and receive a final response?*

 <Select YES or NO>

{If YES, then fill in this question}

Original Dispute Case Number <Fill in #, optional>

22

24 Are you calling *

__ about your personal mortgage or on behalf of a family member or friend?

__ on behalf of a mortgage related company?

<Beginning> button

<Previous> button

<Next> button

24

25 {If the person is calling “on behalf of a mortgage related company” (from S#24)}

We are not able to address industry questions over the phone, but I would be happy to provide you with 

an email address where you can submit your question or concern.
Agent Scripts March 1, 2015 V5.01 

Script # Script Text Comments/Notes 

The email address is cfpb_respainquiries@cfpb.gov (Note: ONLY for industry use). 

 

<Go to Closing> button

<Beginning> button

<Previous> button

25

26 If consumer has already identified one of the issues below, confirm and select their issue below.

If consumer has NOT identified the reason for calling then say: "I'd be happy to help you with that. Are 

you unable to make payment and concerned about foreclosure, OR do you have a mortgage complaint 

about a specific institution OR do you have general questions about the mortgage process?" Based on 

consumer's response, select option below.

__ 1) Has a concern about foreclosure or is unable to make payments

__ 2) Has a question about their loan or the mortgage process

__ 3) Has a mortgage related complaint regarding a specific institution

<Beginning> button

<Previous> button

<Next> button

26

4/13/13 Note: Remove 

27 Is this about something you observed while working for a financial institution or financial service 

provider?* <select YES or NO> 

 

If the caller needs clarification: By asking this question we are identifying ‘whistleblowers’ and ‘tipsters’. 

If you work at a financial institution or financial service provider you may have specialized industry 

knowledge. 

{Dynamic, if YES to whistleblower}

Since you’ve answered “yes” that this is something you observed while working for a company that offers 

financial products or services, your information will not be sent to the company you are complaining 

about. Is there any relationship between your employer and the company you are complaining about that 

would be a reason that you would not want your complaint sent to the company?

Default Values:

• Whistleblower = NO

• Send to Company = 

YES

4/2014
Agent Scripts March 1, 2015 V5.01 

Script # Script Text Comments/Notes 

HT: If the consumer doesn’t object to sending the complaint to the company then change the 

whistleblower question to ‘NO’ and continue taking the complaint

If consumer says there is a reason to not send the information to the company refer to the Whistleblower 

Hotline (855) 695-7974 or CFPB_Whistleblower@cfpb.gov 

 

What Happened? <fill in What Happened explanation, optional>

 

<Save Whistleblower Case> button

<Beginning> button 

Do you want the CFPB to send your complaint to the company?* <Select YES or NO> 

{Dynamic, if No to Send to Company} 

For most complaints, the CFPB forwards some information to the company you identify. If you do not 

want us to send any information to them, we may not be able to take action. All complaints will be used to 

help the CFPB understand consumers’ experiences and monitor providers of financial products and 

services. 

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27

 

28 Before we begin, let me describe the complaint process to you so you will understand what to expect. 

We've tried to make it as easy as possible to submit a complaint. The best way to submit is on our 

website consumerfinance.gov. This is the most time-effective for you, as well as the most accurate for us. 

You can also submit a complaint by phone, mail, or fax. However, if you plan on attaching any supporting 

documentation, you may want to submit online or by fax or mail.

Once you have submitted your complaint, it will be sent to the company for review and they will have 15 

calendar days to respond to your complaint. If you provide an email address, you will receive electronic 

notices about your complaint and will be able to access that information online at consumerfinance.gov. 

Your email address will serve as your login ID and you will need to create a password the first time you 

login.

{If Product / Sub Product = Money transfer/International...}

It’s a good idea to also contact the company as soon as possible if you think it made a mistake. 
Agent Scripts March 1, 2015 V5.01 

Script # Script Text Comments/Notes 

Information about how to contact the company may be on the receipt you received.

Which method do you prefer to submit your complaint?

__ Web

__ Phone

__ Fax/Mail/Paper Form

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28

29 I will be happy to take your complaint over the phone. I do need to inform you that you will not be able to 

attach any documentation to your complaint after I open a case for you today. If you have documentation 

to add to your complaint, you may complete your complaint on our website and attach your documents, or 

submit your complaint to CFPB by fax or by mail. Would you still like to submit your complaint by phone 

today?

Before we begin, I need to read to you official disclosure statements to make sure that you understand 

your rights and what we can provide as a part of this process. After I read the statements, I will ask you if 

you understood.

 

The Paperwork Reduction Act is a federal law that requires the approval of certain federal questionnaires. 

The Office of Management and Budget has approved these questions under the Paperwork Reduction 

Act. On average, answering these questions takes about 10 minutes. The length of time to complete your 

complaint depends on the complexity of the complaint.

 

Also, a federal law called the Privacy Act directs how the federal government (or the CFPB) collects, 

keeps and shares your personal, private Information- including the personal information contained in your 

answers to these questions. To understand how and when your information may be shared, you can read 

the Privacy Act Statement on our website, consumerfinance.gov. 

 

The Consumer Financial Protection Bureau cannot act as a court of law or as a lawyer on your behalf, 

and we cannot give you legal or financial advice.

Do you understand these disclosures as I have read them to you?* 

 <select YES or NO> 

{Dynamic, Pop Up message if No } 

I understand parts of the disclosure can be confusing. However without your acknowledgement of the 

disclosure I won’t be able to continue through the complaint form. Do you have some questions about the 
Agent Scripts March 1, 2015 V5.01 

Script # Script Text Comments/Notes 

disclosure that I could answer to make you more comfortable?

<click pop up to close>

Do you now understand and agree to continue?

 <select YES or NO>

{If NO, go to closing as an Inquiry}

Additional References:

Privacy Act Statement Knowledgebase answer 230

Process the complaint will follow: Knowledgebase answer (not yet developed)

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29

30 Do you want to submit this form to CFPB anonymously?* 

 <select YES or NO> 

{Dynamic, if YES to Anonymous question}

For most complaints, the CFPB forwards some information to the company you identify. You can submit 

anonymously, but we may not be able to take action. All complaints will be used to help the CFPB 

understand consumers’ experiences and monitor providers of financial products and services.

 

Dynamic, if NO to Anonymous question}

OK, I’ll need to get your contact information. May I have your name please?

 

Check for existing contact.

Specifically ask for email address when creating the contact record. 

If existing contact found, follow established identity verification procedures before proceeding to the next 

page (Knowledgebase 998).

Contact* <connect to Contact Search record>

Salutation <choose one, optional>

First Name* <update name, optional> 

Middle Name <update name, optional> 

Last Name* <update name, optional> 

Suffix <fill in suffix>

Anonymous question default 

value = NO
Agent Scripts March 1, 2015 V5.01 

Script # Script Text Comments/Notes 

Address* <click on Edit hyperlink, update pop up, optional>

Primary Phone <update phone, optional> {Use arrow down button to select phone type (e.g. mobile, fax 

etc.)}

Email <update email, optional> {Use arrow down button to select email type (e.g. email, email alt1, etc.)}

{Dynamic once contact is entered.}

VERIFY THE FULL MAILING ADDRESS ABOVE. Click on Address <Edit>. Is the Street, City, Country, 

State/Prov., AND Postal code populated? If not, update these values before continuing. * 

<Select YES or NO> buttons

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30

31 

Product:

Credit card, 

Consumer 

loan (incl. 

Title & 

Pawn), 

Bank 

Acct/Svc. 

Student 

loan, 

Mortgage, 

Money 

transfer

{Skip this script for HL Product = Debt collection}

{For HL Products other than Credit Reporting & Payday; allows both ‘yourself ‘ AND ‘someone’ else to be 

selected concurrently}

Are you filing on behalf of yourself?* < select YES or NO> 

On behalf of someone else? <Select YES or NO> 

{Dynamic, if HL Product = Money Transfers, ask the following question(s) depending on the answers 

provided to the 2 questions show above for this script page}

 

If the answer to ‘Are you filing on behalf of yourself?’ = YES 

Are you: < select one: __ Sender __ Recipient __ Filing on behalf of someone else>

If the answer to “On behalf of someone else?” = YES

Is the person on whose behalf you are filing this complaint <select one: __ Sender ___ Recipient> 

{If the Contact is the Sender or the Recipient, Contact name and address (not phone or email) should be 

copied to the Sender or Recipient field accordingly, upon saving the case}

{Dynamic if filing on ‘behalf of someone else.}

Default Values:

• Are you filing...yourself? 

= YES

• Are you filing..someone 

else? = “Choose”

• Are You = Choose
Agent Scripts March 1, 2015 V5.01 

Script # Script Text Comments/Notes 

Relationship (to the someone else)* <select one>

__ Family Member

__ Friend

__ Attorney

__ Government Employee

__ Advocate

__ Housing Counselor

__ Other

If you are filing a complaint on behalf of someone else, we may need this person’s signed, written 

permission to take action.

Salutation <choose one, optional>

First Name* <fill in name>

Middle Name <fill in name, optional>

Last Name* <fill in name>

Suffix <choose one, optional>

Country* <choose one, US default>

Address 1* <fill in address>

Address 2 <fill in address, optional>

City* <fill in city>

State* <choose state code, REQUIRED if US = Country>

Zip code* <fill in zip, REQUIRED if US =Country>

Phone <fill in phone, optional>

Email <fill in email, optional>

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31

31 

Product: 

Payday, 

Prepaid 

card, Other 

financial 

service

{For HL Products = Payday loan, Other financial service, Prepaid}

Are you filing on behalf of yourself?* < select YES or NO> 

On behalf of Someone Else? <Select YES or NO, cannot be YES if prior question = YES> 

{Dynamic if filing on ‘behalf of someone else = YES}

Relationship (to the someone else)* <select one> 

__ Family Member

__ Friend

__ Attorney

Default Values:

• Are you filing...yourself? 

= YES

• Are you filing..someone 

else? = “Choose”

Default Values:

• Relationship = “Choose”

• Country = “US”
Agent Scripts March 1, 2015 V5.01 

Script # Script Text Comments/Notes 

__ Government Employee

__ Advocate

__ Housing Counselor

__ Other

If you are filing a complaint on behalf of someone else, we may need this person’s signed, written 

permission to take action.

Salutation <choose one, optional>

First Name* <fill in name>

Middle Name <fill in name, optional>

Last Name* <fill in name>

Suffix <choose one, optional>

Country* <choose one, US default>

Address 1* <fill in address>

Address 2 <fill in address, optional>

City* <fill in city>

State* <choose state code, REQUIRED if US = Country>

Zip code* <fill in zip, REQUIRED if US =Country>

Phone <fill in phone, optional>

Email <fill in email, optional>

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31

32 Restate and confirm the product/sub-product with the consumer or ask them directly based on the options 

in the product/sub-product field below.

Product/Sub-product*

 <fill in HL product and sub-product from product drop down list>

{Dynamic, if Product = Student loan}

Currently the CFPB is only receiving complaints for non-federal student loans.

Which of these best describes your complaint issue?*

<fill in Issue from the drop down list related to the Product/Sub-product chosen> 

{ Dynamic based on HL Product/Sub-product selected}

Jan 2014 Note: S#32 Student 

Loan Issues changed. Old 

issues continue to appear, but 

Agent will receive pop-up error 

message if selected.
Agent Scripts March 1, 2015 V5.01 

Script # Script Text Comments/Notes 

{Mortgage}

{If Product / Sub-product = Other Mortgage then add dynamic extra question}

Mortgage – Type Other* <fill in text box>

{For all mortgage sub-products the following Issue helper text also appears}

Applying for the loan

Application, originator, mortgage broker

Receiving a credit offer 

Credit decision/Underwriting

Signing the agreement

Settlement process and costs

Making payments

Loan servicing, payments, escrow accounts

Problems when you are unable to pay

Loan modification, collection, foreclosure

 

{Bank account or services} 

Account opening, closing or management

Confusing marketing, denial, disclosure, fees, closure, account access, interest, statements, joint accounts

Deposits and withdrawals

Availability of deposits, withdrawal problems and penalties, unauthorized transactions, check cashing, payroll deposit 

problems, lost or missing funds, transaction holds

Using a debit or ATM card

Disputed transaction, unauthorized card use, ATM or debit card fees, ATM problems

Making or receiving payments 

Problems with payments by check, card, phone, or online, unauthorized or fraudulent transactions.

Problems caused by my funds being low

Overdraft fees, late fees, bounced checks

{Consumer loan/ Vehicle loan, vehicle lease, installment loan }

Shopping for a loan or lease

Sales tactics or pressure, credit denial, confusing

Taking out the loan or lease

Term changes (mid-deal changes, changes after closing, etc.), required add-on products, trade-in

Managing the loan or lease

Billing, late fees, damage or loss, Insurance (GAP, credit etc.) privacy 

Problems when you are unable to pay

Repossession, deficiency, bankruptcy, default

{Consumer loan / Personal line of credit} 

Shopping for a credit line

Confusing advertising or marketing, credit denial
Agent Scripts March 1, 2015 V5.01 

Script # Script Text Comments/Notes 

Account terms and changes

Term changes (rates, fees, etc.), access, line reduction, suspension or termination

Managing the line of credit

Billing, late fees, privacy

Problems when you are unable to pay

Repossession, deficiency, bankruptcy, default

{ Consumer loan/ Pawn loan}

Charged unexpected fees or interest

Can’t stop charges to bank account

Received a loan I didn’t apply for

 

Applied for loan/did not receive money 

Charged bank acct wrong day or amt. 

Payment to acct not credited 

Can’t contact lender 

Lender sold the property 

Lender damaged or destroyed property 

{ Consumer loan / Title Loan}

Charged unexpected fees or interest

Can’t stop charges to bank account

Received a loan I didn’t apply for

 

Applied for loan/did not receive money 

Charged bank acct wrong day or amt 

Payment to acct not credited 

Can’t contact lender 

Lender repossessed or sold the vehicle 
Agent Scripts March 1, 2015 V5.01 

Script # Script Text Comments/Notes 

Lender damaged or destroyed vehicle 

{Credit card} - no Helper Text

{Credit reporting - NO Helper Text needed because scripting flow skips this. Issue and Sub-Issue has been 

previously selected}

{For Other financial service/ Check cashing, Debt settlement, Credit repair}, 

Advertising and marketing 

 

Customer service/Customer relations 

 

Disclosures 

 

Excessive fees 

Unexpected/Other fees 

 

Fraud or scam 

{For Foreign currency exchange}

Advertising and marketing 

 

Customer service/Customer relations 

 

Disclosures 

 

Excessive fees 

Unexpected/Other fees 

Incorrect exchange rate 

 

Fraud or scam 

For Other financial service/ Travelers/Cashiers ck,, Money order, Refund antic loan} 

Advertising and marketing 

 
Agent Scripts March 1, 2015 V5.01 

Script # Script Text Comments/Notes 

Customer service/Customer relations 

 

Disclosures 

 

Excessive fees 

Unexpected/Other fees 

Lost or stolen 

 

Fraud or scam 

{For Money transfers}

Money was not available when promised 

 

Wrong amount charged or received 

Transfer amount, fees, exchange rates, taxes, etc.

 

Incorrect/missing disclosures or info 

 

Other transaction issues 

Unauthorized transaction, cancellation, refund, etc.

Other service issues 

Advertising or marketing, pricing, privacy, etc.

Fraud or scam 

{For Prepaid Card}

Managing, opening, or closing account 

 

Fees 

 

Unauthorized transactions/trans. issues 

 

Advertising, marketing or disclosures 

Adding money 

Overdraft, savings or rewards features 
Agent Scripts March 1, 2015 V5.01 

Script # Script Text Comments/Notes 

 

Fraud or scam 

{Student loan}

Getting a loan 

Denial, confusing advertising or marketing, sales tactics or pressure, financial aid services, recruiting, fraudulent loan.

 

Can’t repay my loan 

Deferment, forbearance, default, bankruptcy, payment plan, refinancing. 

 

Dealing with my lender or servicer

Making payments, getting information about my loan, managing my account.

{Debt collection}

Communication tactics 

Frequent or repeated calls; called outside of 8am-9pm; used obscene, profane or other abusive language; threatened 

to take legal action; frequent or repeated calls; called after sent written cease of communication notice

Continued attempts to collect debt I do not owe 

Debt was discharged in bankruptcy; debt resulted from identity theft; debt was paid; debt is not mine

Disclosure verification of debt 

Did not receive notice of right to dispute; did not provide enough information to verify debt (i.e. amount of debt and 

name of creditor is owed); did not disclose communication was an attempt to collect debt

 

Improper contact or sharing of information 

Contacted me after I asked not to; contacted my employer after I asked not to; contacted me instead of my attorney; 

talked to a third party about my debt.

 

False statements or representation 

Attempt to collect wrong amount; impersonating attorney, law enforcement or government official; indicate committing 

crime by not paying debt; indicate should not respond to lawsuit.

 

Taking or threatening to take an illegal action 

Threaten to arrest me or take me to jail if I do not pay, threaten to sue me on debt that is too old to be sued on; sued 

me without properly notifying me of lawsuit, sued me when I did not live or did not sign for the debt; actual or attempt 

to collect exempt funds (i.e. social security, worker’s compensation, unemployment or child support; actual or attempt 

to seize property.

{Payday loan}
Agent Scripts March 1, 2015 V5.01 

Script # Script Text Comments/Notes 

Charged fees or interest I didn’t expect 

Consumer was charged fees or interest that he or she did not expect.

 

Can’t stop charges to bank account 

Consumer was unable to stop the lender from charging his or her bank account

 

Received a loan I didn’t apply for 

Consumer received a loan that he or she did not apply for.

 

Applied for loan / did not receive money 

Consumer applied for a loan but did not receive money.

 

Charged bank acct wrong day or amt 

The lender charged the consumer’s bank account on the wrong day or in the wrong amount.

 

Payment to acct not credited 

The lender did not credit a payment to the consumer’s account.

 

Cannot contact lender 

Consumer was unable to contact the lender.

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32

33 {Dynamic, If the product is Mortgage AND the issue is “Loan Modification, collection, foreclosure”}

Are you concerned about losing your home to foreclosure? <Select Yes or NO>

{Dynamic section if Answer = YES}

Have you missed payments or are you in default on your mortgage? This includes if your mortgage 

company believes you are in default or have missed payments, even if you believe your mortgage 

company is in error. <select YES or NO> 

 

Is there a date that is scheduled for the foreclosure sale of your home? If a foreclosure sale has been 

scheduled, you might have received a Notice of Sale or Order Setting Sale. 

<select YES or NO> 

{Dynamic if preceding answer is YES}

What is the date of the scheduled foreclosure sale?

 <select date from RN calendar> 

Default Values:

• Are you concerned 

about losing your 

home.... = Choose
Agent Scripts March 1, 2015 V5.01 

Script # Script Text Comments/Notes 

Some companies may charge homeowners a fee for services described as foreclosure defense, 

foreclosure prevention, foreclosure rescue, or loss mitigation assistance. 

Did you hire one of these companies to help you avoid foreclosure? <Select Yes or NO>

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33

34 {Credit card product only}

If you lost money, how much money did you lose? <fill in $$ amount>

When did this happen? <choose date from calendar>

Have you done any of these things to try to resolve this issue? <select one or more>

Contacted the Company directly <select YES or NO>

Contacted the Consumer Financial Protection Bureau <select YES or NO>

Hired an Attorney <select YES or NO>

Contacted Gov’t Agency <select YES or NO>

Filed Legal Action <select YES or NO>

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34

35 REMOVED (Discrimination scripting) 

35

REMOVED BASED ON CR367 

(Aug. 2013)

36 Describe your complaint. Include facts about what happened and any steps you have taken to resolve the 

issue.

Dynamic, HL Product = Payday loan}

{If Issue = Charged unexpected fees or interest} Please include in your explanation the amount of fees or 

interest that was paid.

{If Issue = Cannot stop charges to bank account} Please include in your explanation the name of the bank 
Agent Scripts March 1, 2015 V5.01 

Script # Script Text Comments/Notes 

and the state in which this bank is located.

{If Issue = Charged bank acct wrong day or amt.} Please indicate in your explanation whether this 

resulted in an overdraft fee.

If consumer attempts to provide sensitive personal information in this description, note that we collect 

account numbers and other sensitive information later in the process in order to have it in a separate 

place and help protect their privacy. 

Enter the company name provided by the consumer. If there is an exact match, you may select from the 

list. Otherwise, enter the full name as provided by the consumer. If clarification is needed, ask or confirm 

what company name shows up on their statement/receipt. If the consumer does not know the company, 

enter Unknown.

{Dynamic, Hidden if HL Product = Debt collection }

Company (As stated by consumer)* <Fill in Company Name> 

I am going to be typing everything you say verbatim. Would you mind speaking at a moderate pace?

Enter complaint description (What Happened).* <Enter What Happened >

{Dynamic, applies to HL Product = Money transfer}

How much was transferred? <fill in amount> 

Amount MUST be in 0.00 format.

Is that amount in U.S. dollars or other currency?<Select Currency Type, USD default value>

Date of transfer? <fill in date>

If the date provided is after today’s date say, “Can you please confirm that the date of the transfer related 

to this complaint is <read the date you recorded”>?” 

When money was sent.

What was the transfer ID or transaction number? <fill in #>

If caller does not know what transfer ID or transaction number is: The Transfer ID or transaction number 

may be found on the money transfer receipt?

Date the funds were promised <fill in date from calendar>

If before the Date of transfer say: “The date you provided is prior to the Date of transfer. Let’s confirm both 

dates to make sure I record them correctly.”
Agent Scripts March 1, 2015 V5.01 

Script # Script Text Comments/Notes 

When funds expected.

When did the issue you just described occur? <fill in date>

If after ‘today’s date” say: “The issue must have occurred today or in the past. Can you verify that date for 

me?”

What is the amount of the error, if any? <fill in $$ amnt>

Amount MUST be in 0.00 format. 

Is that amount in U.S. dollars or other currency? <fill in currency, default to US>

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36

37 {ALL PRODUCTS}

What do you think would be a fair resolution?*

< Enter resolution?>

If consumer attempts to provide sensitive personal information in this description, state: "We collect 

account numbers and other sensitive information later in the process in order to have it in a separate 

place and help protect your privacy."

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37

38 

Product:

Money 

Transfer

{HL Product = Money Transfer for SENDING INFORMATION}

Confirm that the company listed is the company that provided the money transfer service and obtain the 

additional information on this page.

What company is this complaint about?

[Company Name Displayed, editable]*

Address 1 <fill in street address, optional>

Address 2 <fill in street address, optional>

City <fill in city name, optional>

State <Fill in State 2 –digit code from drop down list, optional>

Zip code <fill in zip orzip+4 for US addresses, optional, >
Agent Scripts March 1, 2015 V5.01 

Script # Script Text Comments/Notes 

Country <Fill in country, Optional>

If the transfer was done from an account with this company, can you provide the Account number? 

Account or Loan number (or Social Security number for Student Loans) <Fill in account number> Only 

ask for Social Security number if the Product is Student Loan.

If the consumer is concerned about providing account information: We use unique information about the account to 

verify that we have the right person to provide to the company and to help make sure the company reviews the 

correct account information. The more information you provide, the easier it will be to review and process the 

complaint

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38

38

Product: 

Mortgage,

Student 

Loan, 

Consumer 

loan (except 

Title and 

Pawn loans),

Credit card, 

Bank 

Acct/Svc.

Prepaid 

card

Other 

financial 

service

{Dynamic depending on HL Product --- DOES NOT INCLUDE HL Product= Payday loan, Money 

transfers, Comer loan/Pawn & Title, Debt collection}

{Mortgage}

Ask for PROPERTY ADDRESS.

Is the Account/Billing/Property address same as the primary contact’s address? <select YES or NO>

{If NO}

Address1*<fill in street address>

Address2 (fill in address, Optional>

City* <Fill in city name> 

State* <Fill in State 2 –digit code from drop down list> 

Zip Code* <fill in zip orzip+4> 

Country* <fill in country from drop down list> 

Account or Loan number (or Social Security number for Student Loans) Only ask for the Social Security 

number if the Product is Student Loan.

<fill in number, Optional>

{Credit card}

Ask for BILLING ADDRESS.

Is the Account/Billing/Property address same as the primary contact’s address? <select YES or NO>

Default values:

• Is 

Account/Billing/Property 

Address...? = YES

• Prop/Billing Address 

State = Choose

• Prop/Billing Address 

Country = US

• Company State = 

Choose

• Company Country = US
Agent Scripts March 1, 2015 V5.01 

Script # Script Text Comments/Notes 

{If NO}

Address1*<fill in street address>

Address2 (fill in address, Optional>

City* <Fill in city name> 

State* <Fill in State 2 –digit code from drop down list> 

Zip Code* <fill in zip orzip+4> 

Country* <fill in country from drop down list> 

Account/Loan Number or Social Security Number <Fill in number, Optional> 

How does the name appear on the credit card/credit report? <fill in name, Optional> 

{Bank acct/svc, Prepaid card, Other financial service }

Ask for ACCOUNT ADDRESS.

Is the Account/Billing/Property address same as the primary contact’s address? <select YES or NO>

{If NO}

Address1*<fill in street address>

Address2 (fill in address, Optional>

City* <Fill in city name> 

State* <Fill in State 2 –digit code from drop down list> 

Zip Code* <fill in zip orzip+4> 

Country* <fill in country from drop down list> 

Account or Loan number (or Social Security number for Student Loans) <fill in number, Optional>

Only ask for the Social Security number if the Product is Student Loan.

{Consumer loan} 

Ask for BILLING ADDRESS.

Is the Account/Billing/Property address same as the primary contact’s address? <select YES or NO>

{If NO}

Address1*<fill in street address>

Address2 (fill in address, Optional>

City* <Fill in city name> 

State* <Fill in State 2 –digit code from drop down list> 

Zip Code* <fill in zip orzip+4> 

Country* <fill in country from drop down list> 

Account or Loan number (or Social Security number for Student Loans) Only ask for the Social Security 
Agent Scripts March 1, 2015 V5.01 

Script # Script Text Comments/Notes 

number if the Product is Student Loan.

<fill in number, Optional>

{Student Loan}

Ask for BILLING ADDRESS.

Is the Account/Billing/Property address same as the primary contact’s address? <select YES or NO>

{If NO}

Address1*<fill in street address>

Address2 (fill in address, Optional>

City* <Fill in city name> 

State* <Fill in State 2 –digit code from drop down list> 

Zip Code* <fill in zip orzip+4> 

Country* <fill in country from drop down list> 

Account or Loan number (or Social Security number for Student Loans) Only ask for the Social Security 

number if the Product is Student Loan.

<fill in number, Optional>

Social Security number MUST be entered in the format ###-##-####.

{Credit reporting - INACTIVE} 

Name on credit report <fill in first middle last>

Social Security Number <Fill in number in xxx-xx-xxxx format> 

Date of Birth <mm/dd/yyyy format>

Name: Insert in First Middle Last order. 

Social Security Number: Enter as xxx-xx-xxxx. 

Date of Birth: Enter in mm/dd/yyyy format only. 

Social Security number MUST be entered in the format ###-##-####.

 

{All products}

What company is this complaint about?

COMPANY ADDRESS

Company (As stated by consumer)* <fill in, editable>

Address 1 <fill in street address, Optional>

Address 2 <fill in street address, Optional>

City <Fill in city name, Optional> 

State <Fill in State 2 –digit code from drop down list, Optional>
Agent Scripts March 1, 2015 V5.01 

Script # Script Text Comments/Notes 

Zip <Fill in zip + 4, Optional>

Country <choose from drop down, “Choose” Default>

{Dynamic, HL product = Other financial service, Prepaid card}

Phone number <Fill in company phone #,Optional>

If the consumer is concerned about providing account information: We use unique information about your account to 

verify that we have the right person to provide to the company and to help make sure the company reviews the 

correct account information. The more information you provide, the easier it will be to review and process your 

complaint.

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38

38

Product:

Payday 

loan

Consumer 

loan/ Title 

and Pawn 

Loans

{Dynamic, HL Product = Payday loan, Consumer loan/Title Loan, Pawn Loan}

Where did you get the loan?

<Select “In person / at a store” or “Online”>

If consumers indicate that they applied online but picked up their loan in person, select “In person 

/ at a store”

{Dynamic, if “In person / at a store” selected}

In which state is the store located? <Select US state, dropdown list>

If the consumer asks why we need this information, say “This is important because different states have 

different laws for payday loans.”

{Dynamic, if “Online” selected}

What is the website you used to apply for the payday loan?

<Fill in web URL>

 

What company is this complaint about?

COMPANY NAME & ADDRESS

Company (As stated by consumer)* <fill in, editable>

Address 1 <fill in street address, Optional>

Address 2 <fill in street address, Optional>

City <Fill in city name, Optional>

Default values:

• Company State = 

Choose

• Company Country = US
Agent Scripts March 1, 2015 V5.01 

Script # Script Text Comments/Notes 

State <Fill in State 2 –digit code from drop down list, Optional>

Zip <Fill in zip + 4, Optional>

Account or Loan number (or Social Security number for Student Loans) Only ask for the Social Security 

number if the Product is Student Loan.

<fill in number, Optional> 

If the consumer is concerned about providing account information: We use unique information about your account to 

verify that we have the right person to provide to the company and to help make sure the company reviews the 

correct account information. The more information you provide, the easier it will be to review and process your 

complaint.

<Beginning> button

<Previous> button

<Next> button

38

39 Are you a Servicemember or Dependent? <Select YES or NO, “Choose” default>

{Dynamic if Answer is YES}

Are you a current or former servicemember?* <Select YES or NO>

Are you a dependent/spouse of a current/former servicemember?* <Select YES or NO>

{Dynamic, if Answer is YES to either of the above 2 questions}

What is the servicemember’s status?* <Select from drop down>

What is the servicemember’s branch of service?* <Select from drop down>

What is servicemember’s rank?* <Select from drop down> 

{Dynamic if Answer is YES to ‘dependent/spouse’ question above} 

Salutation <choose one, optional>

First Name* <fill in name>

Middle Name <fill in name, optional>

Last Name* <fill in name>

Suffix <choose one, optional>

Country* <choose one, United State = Default>

Address 1* <fill in address>

Default Values:

• Are you a 

Servicemember or 

Dependent = “Choose”
Agent Scripts March 1, 2015 V5.01 

Script # Script Text Comments/Notes 

Address 2 <fill in address, optional>

City* <fill in city>

State* <choose state code>

Zip code* <fill in zip>

<Beginning> button

<Previous> button

<Next> button

39

40 Before I submit your case, I would like to recap your complaint and your desired resolution. 

What Happened?* <See and edit what happened>

 

Desired Resolution?* <See and edit resolution>

For CFPB tracking purposes, can you provide me with your age? <Fill in Age, Editable>

Thank you. 

Is the information provided true to the best of your knowledge and belief and do you understand that the 

Consumer Financial Protection Bureau cannot act as a court of law or a lawyer on your behalf, and we 

cannot give you legal or financial advice?

Do you agree?* <Select YES or NO>

{Dynamic, if YES}

<Submit Complaint> button

{Dynamic, if No}

<Submit Feedback> button

{Pop Up Message if Feedback is chosen}

"Are you sure you would like to submit this complaint as feedback?

Without your acknowledgment, CFPB will not be able to communicate with you and will not be able to 

investigate the issue."

Agent Instruction:

Note: Submit button will SAVE 

the cases.
Agent Scripts March 1, 2015 V5.01 

Script # Script Text Comments/Notes 

If it is actually a complaint, Click "OK" and confirm that the consumer agrees to the statement by 

Selecting "Yes" and then Click "Submit Complaint".

If it is feedback (or the Consumer does not agree), Click "OK" and then Click "Submit Feedback".

<OK> button

<Beginning> button

<Previous> button

40

40 {This is the view of S#40 after the <Submit Complaint> or <Submit Feedback> button is clicked}

Please proceed to next page to review and properly save the case. 

<Next> button

40

41 Your feedback has been submitted. We will include the information you provided in our database for 

analysis and to help with supervisory and other efforts. Thanks you.

<Close> button

41

42 Your complaint has been submitted.

Your case number is ######-######. 

{Dynamic, HL Product = Debt collection ,and original creditor (OC) case if OC case is being filed}

Your other case number is ######-######

You can track your complaint online with a valid email address, if you provided one, by going to 

consumerfinance.gov.

Click "Get Assistance..."

Then Click "Check the status of a complaint.” 

We will send all updates and correspondence regarding this case to the email address provided or you 

can call us at 1 (855) 411- CFPB (2372) to get updates. 
Agent Scripts March 1, 2015 V5.01 

Script # Script Text Comments/Notes 

Advise the consumer that they will need to create a password when they first attempt to log on to the 

consumer portal to check their status.

(If no email address was provided, go to the Contact record to update the email address.)

If consumer asks what happens next, read the following:

The Consumer Financial Protection Bureau will review your complaint to make sure we send it to the right 

company. When we send it to them, we will ask them to respond to us and to you within 15 calendar days 

after CFPB sends the complaint to the company. Just be sure to keep your case number for any future 

contact with us.

Thank you for calling the Consumer Financial Protection Bureau. Remember, you can also find more 

information at consumerfinance.gov.

<Close> button

42

43 You can mail or fax us a letter explaining your complaint or you can mail us the complaint form.

If Complaint Form - When you send in the complaint form be sure that you send in copies of all the 

documents you would want included with your complaint form or complaint letter. If you send in originals 

they will not be returned. Once your complaint is processed you cannot attach any documents.

If Fax/Mail – Be sure that you send or fax copies of all the documents you would like to be included with 

your complaint form or complaint letter. If you send or fax originals they will not be returned. Once your 

complaint is processed you cannot attach any documents. 

{Dynamic, if HL Product = Debt collection}

For debt collection complaints, we require a signed form. I will be happy to send you our CFPB complaint 

form by mail to complete and return.

{NOTE: Will only appear if the HL Product is NOT Debt collection}

Note: If consumer wants to mail the complaint form to the CFPB, then ask consumer for their mailing 

address and send paper complaint form to the address they provide.

Please include your:

- Name 

- Mailing Address
Agent Scripts March 1, 2015 V5.01 

Script # Script Text Comments/Notes 

- Phone Number

- Company Name

- Company Mailing Address

- Account Number

- Desired Resolution

- Details of any communication you have had with the company about the issue

The CFPB mailing address is: 

Consumer Financial Protection Bureau 

PO Box 4503 

Iowa City, IA 52244 

or

Fax to (855) 237-2392 

HT: CFPB Phone # : (855) 411-CFPB (2372) 

Once we receive and process your complaint, we will respond to you with your case number.

Set Disposition to “Publication/Forms Request” and select the correct language. Record as a Private Note 

the number of forms being requested by the consumer.

{Will appear if HL Product = Mortgage}

In addition to filing your complaint by mail as I just described, may I ask if you are unable to make your 

payments and are concerned about a possible foreclosure?

< Select YES or NO>

<Go to Closing> button

<Beginning> button

<Previous> button

<Next> button

43

44 SCRIPT REMOVED JULY 2013

44

4/13/13 Note: Independent 

Foreclosure Review removed 

45 Are you a veteran or member of the military?* < select Yes or No>

45
Agent Scripts March 1, 2015 V5.01 

Script # Script Text Comments/Notes 

46 Because of your military service you may be eligible for special benefits and personalized assistance from 

the Department of Veterans Affairs’ Home Loan Office. Would you like to be connected to the Department 

of Veterans Affairs’ Home Loan Office?

Provide the contact information for the Department of Veterans Affairs’ Home Loan Office and then cold 

transfer. 

Thank you. I will connect you now.

The number to the Department of Veterans Affairs’ Home Loan Office is 1 (877) 827-3702. 

<Got to Closing> button

<Beginning> button

<Previous> button

<Next> button

46

47 I can connect you to the Homeowner’s HOPETM Hotline to speak with a housing counselor who will assist 

you at no charge to you. The HOPE hotline offers personalized advice from housing counseling agencies 

approved by the U.S. Department of Housing and Urban Development (HUD). This national hotline is 

open 24 hours a day, 7 days a week. 

Let me connect you with someone now. Please hold for a moment while I connect you to the 

Homeowner's HOPETM Hotline.

I can also provide you their contact information if we are disconnected.

The phone number is 1 (888) 995-HOPE and the web address is www.hopenow.com. 

This must be a cold transfer as the Hotline has a disclosure that must be heard by consumer. 

<Caller is reluctant to be transferred to HOPE> button

<Go to Closing> button

>Beginning> button

<Previous> button

47

48 I'd be happy to help you with that. To best assist you, I need to ask you a few questions.
Agent Scripts March 1, 2015 V5.01 

Script # Script Text Comments/Notes 

Would you like to continue via internet or by phone?*

< Internet> button

<Phone> button

<Beginning> button

<Previous> button

48

49 You may want to refer to the U.S. Department of Housing & Urban Development website at www.hud.gov

or call 1 (800) 569-4287 to identify a HUD-approved housing counselor in your area.

You may also find information on our website consumerfinance.gov 

Are you comfortable with this direction?

If Yes: Click on Go to Closing

 

IF No and the consumer asks for additional assistance with searching: 

Okay. I'd be happy to walk you through the tool if you'd like.

Help the consumer get to consumerfinance.gov/askcfpb and click on the appropriate Product & 

keyword(s). Describe what you are viewing and confirm if the caller has located the desired information. 

<Go to Closing> button

<Beginning> button

<Previous> button

49

50 Search the Knowledgebase using keywords.

If the answer is not readily available in the Knowledgebase, refer to approved website links list. 

 

OR 

 

Open consumerfinance.gov in your browser. 

Select Get Assistance. 

Select the appropriate topic from the dropdown list.

 

OR 
Agent Scripts March 1, 2015 V5.01 

Script # Script Text Comments/Notes 

You may want to call the U.S. Department of Housing & Urban Development at 1 (800) 569-4287 or go to 

the website at www.hud.gov to identify a HUD-approved housing counselor in your area.

<Go to Closing> button

<Beginning>button

<Previous> button

50

51 If consumer has not already been clear about why they are reluctant to be transferred to HOPE then ask 

consumer why they are reluctant and select the most appropriate reason below. 

 

__ Could not reach someone on the Homeowner’s HOPETM Hotline

__ Already talked to the Homeowner’s HOPETM Hotline and that they aren’t helping

__ Wants CFPB to help directly instead of the Homeowner’s Hope Hotline

__ Already worked with the Homeowner’s HOPETM Hotline but HOPE cannot resolve a possible 

foreclosure scam to the consumer’s satisfaction

___Already gave information to the Homeowner’s HOPETM Hotline but the company I complained about is 

still in business

__Wants CFPB to sue on their behalf

__ Does not want to be transferred to Homeowner’s HOPETM Hotline (no specific reason)

__ Consumer wants to file a mortgage complaint about a specific institution.

51

52 Let me connect you with someone now. Please hold for a moment while I connect you to the 

Homeowner's HOPETM Hotline.

I can also provide you their contact information if we are disconnected.

The phone number is 1 (888) 995-HOPE and the web address is www.hopenow.com. 

This must be a cold transfer as the Hotline has a disclosure that must be heard by consumer. 

 

<Go to Closing> button

<Beginning> button

<Previous> button

52

53 We are sorry to hear this. Please understand that there are a lot of people contacting the HOPETM Hotline 

for help right now. You may want to refer to the U.S. Department of Housing & Urban Development 

website at www.hud.gov or call 1 (800) 569-4287 to identify a HUD-approved housing counselor in your 

area. 
Agent Scripts March 1, 2015 V5.01 

Script # Script Text Comments/Notes 

You may also want to go to the CFPB website at consumerfinance.gov for information about other 

resources available in your area.

If you decide to contact the HOPETM Hotline in the future, the phone number is 1 (888) 995-HOPE and the 

web address is www.hopenow.com.

<Consumer does NOT want to be connected to HOPE> button

<Go to Closing> button

<Beginning> button

<Previous> button

53

54 The CFPB and the U.S. Department of the Treasury have teamed up with the Homeowners’ HOPETM 

Hotline to connect you with housing counselors who will assist you at no charge. The housing counselors 

have been approved by the US Department of Housing and Urban Development and are specially trained 

to provide you with personal assistance with these issues. We highly recommend using this resource. 

Alternatively, you can follow up with your mortgage company directly if you prefer.

 

I can also provide you their contact information if we are disconnected.

The phone number is 1 (888) 995-HOPE and the web address is www.hopenow.com. 

This must be a cold transfer as the Hotline has a disclosure that must be heard by consumer. 

< Consumer does NOT want to be connected to HOPE> button

<Go to Closing> button

<Beginning> button

<Previous> button

54

55 We are sorry to hear that. The HOPETM Hotline can only collect information on a possible scam and refer it 

to a centralized database where it can then be reviewed by appropriate authorities. Please know that by 

reporting the potential scam, you are doing a public service. The more information we can assemble on a 

scam operation, the greater the likelihood action can be taken by the appropriate regulator.

Would you like me to connect you with the HOPE Hotline right now?
Agent Scripts March 1, 2015 V5.01 

Script # Script Text Comments/Notes 

I can also provide you their contact information if we are disconnected.

The phone number is 1 (888) 995-HOPE and the web address is www.hopenow.com. 

This must be a cold transfer as the Hotline has a disclosure that must be heard by consumer. 

< Consumer does NOT want to be connected to HOPE> button

<Go to Closing> button

<Beginning> button

<Previous> button

55

56 You may want to refer to the U.S. Department of Housing & Urban Development website at www.hud.gov

or call 1 (800) 569-4287 to identify a HUD-approved housing counselor in your area.

You may also want to go to the CFPB website at consumerfinance.gov for information about other 

resources available in your area. HT: CFPB Phone # : 1 (855) 411-CFPB (2372) 

Here’s the information to contact HOPE if you change your mind in the future: 1 (888) 995-HOPE or 

www.hopenow.com. 

<Go to Closing> button

<Beginning> button

<Previous> button

56

57 We are sorry to hear that. The HOPETM Hotline can only collect information on a possible scam and refer 

it to a centralized database where it can then be reviewed by appropriate authorities. Please know that by 

reporting the potential scam and reporting its continued operation, you are doing a public service. The 

more information we can assemble on a scam operation, the greater the likelihood action can be taken by 

the appropriate regulator.

Would you like me to connect you with the HOPE Hotline right now?

I can also provide you their contact information if we are disconnected.

The phone number is 1 (888) 995-HOPE and the web address is www.hopenow.com. 

This must be a cold transfer as the Hotline has a disclosure that must be heard by consumer. 
Agent Scripts March 1, 2015 V5.01 

Script # Script Text Comments/Notes 

Advise the consumer to ask for the Anti-Scam Dedicated Team.

< Consumer does NOT want to be connected to HOPE> button

<Go to Closing> button

<Beginning> button

<Previous> button

57

58 Unfortunately, we cannot assist you with bringing a civil lawsuit in your name against any entity. 

However, the CFPB website has information on other resources that may help you. 

 

Also, the HOPETM Hotline has suggestions for resources that might be able to assist you with this. Would 

you like me to connect you to the HOPE Hotline?

I can also provide you their contact information if we are disconnected.

The phone number is 1 (888) 995-HOPE and the web address is www.hopenow.com.

This must be a cold transfer as the Hotline has a disclosure that must be heard by consumer. 

< Consumer does NOT want to be connected to HOPE> button

<Go to Closing> button

<Beginning> button

<Previous> button

58

59 It is very important that you have all your documents ready to upload when you go on to our website to file 

your complaint. The product information tab of the complaint will allow you to upload any supporting 

documents. Please be sure that you upload your documents prior to submitting your complaint. No 

documents can be attached to your complaint after you have submitted the complaint. 

Offer to guide the consumer to the web form.

Please visit our website at consumerfinance.gov to submit your complaint online.

HT: CFPB Phone # : 1 (855) 411-CFPB (2372) 

If you are having trouble uploading your documents, assistance in completing the complaint online may 

be provided by a chat agent. Just click on the link shown on the complaint form label “Form trouble? Chat 

Now“ to connect to a chat agent.
Agent Scripts March 1, 2015 V5.01 

Script # Script Text Comments/Notes 

<Go to Closing> button

<Beginning> button

<Previous> button

<Next> button

59

60

[standard 

script page]

Before we close may I have your name?

Contact* <Enter contact info or Anonymous contact record, Editable> 

<Click if consumer does NOT want to provide contact info> button

Product* <HL Product/Sub Product, Editable>

Which best describes your issue?* <Issue/Sub Issue Editable>

Disposition* <select Disposition from drop down list> 

Status* <Status Editable>

Agent Reminder Notes: 

1. Do not provide consumers with a case number unless the consumer specifically asks for a case 

number. 

2. Be sure to include information about a referral as a Private Note (on the Message tab).

3. Be sure to click the <Submit Inquiry> button FOLLOWED BY the <Close> button to properly save 

the case.

Thank you for calling the CFPB. You can also find more information at consumerfinance.gov. 

<Submit Inquiry> button

{After clicking, <Submit Inquiry> button, this ‘closing pop up is displayed.} 

<Close> button

<Beginning> button

<Previous> button

60

Note: All fields will become 

“READ ONLY” after the “Submit 

Inquiry” button is clicked and the 

closing pop up is displayed.

60

[2015 

customer 

Before we close may I have your name?

Contact* <Enter contact info or Anonymous contact record, Editable> 

Note: All fields will become 

“READ ONLY” after the “Submit 

Inquiry” button is clicked and the 
Agent Scripts March 1, 2015 V5.01 

Script # Script Text Comments/Notes 

service 

survey

page – 

temporary 

script 

language 

highlighted] 

<Click if consumer does NOT want to provide contact info> button

Product* <HL Product/Sub Product, Editable>

Which best describes your issue?* <Issue/Sub Issue Editable>

Disposition* <select Disposition from drop down list> 

Status* <Status Editable>

Agent Reminder Notes: 

1. Do not provide consumers with a case number unless the consumer specifically asks for a case 

number. 

2. Be sure to include information about a referral as a Private Note (on the Message tab).

3. Be sure to click the <Submit Inquiry> button FOLLOWED BY the <Close> button to properly save 

the case.

Are you willing to take a short, anonymous survey about your experience today?

{If consumer says “Yes”, say:} 

Thanks. Now I’m going to connect you with someone else for the survey.

Transfer call and then continue to the Submit Inquiry button. 

{If consumer says “No”, say:}

Thank you for calling the CFPB. You can also find more information at consumerfinance.gov. 

<Submit Inquiry> button

{After clicking, <Submit Inquiry> button, this ‘closing pop up is displayed.} 

<Close> button

<Beginning> button

<Previous> button

60

closing pop up is displayed.

61 You must re-select Question or Complaint before being able to continue.

<Click to re-select Question or Complaint> button

61

62 You must re-select whether related to a personal mortgage or on behalf of a mortgage related company 
Agent Scripts March 1, 2015 V5.01 

Script # Script Text Comments/Notes 

before being able to continue.

<Click to re-select Personal or Company> button

62

63 Where did the transaction take place?

<Drop down or radio button selection, choose ONE> 

__ Online 

__ In person, phone, fax

{Dynamic depending on where transaction took place}

{IF Online}

What is the web site or mobile app that was used? <Text box to fill in URL or app name>

{IF In Person/Phone/Fax}

Company(Sender Agent)*<fill in company name>

Country (Sender Agent)* <fill in country from drop down list, ‘Choose’ Default>

Address1 (Sender Agent) <fill in street address, optional>

Address 2 (Sender Agent)<fill in street address, optional>

City (Sender Agent)<fill in city name, optional>

State (Sender Agent)* <Required if US only. code from drop down list >

Zip Code (Sender Agent) <fill in zip orzip+4, optional>

Telephone (Sender Agent) <fill in phone number, optional> 

{DYNAMIC, If the Primary Contact or the On Behalf of person are NOT the sender the name and address 

fields are presented for Agent to complete. Otherwise they are hidden.}

Salutation (Sender) <choose one, optional> 

First Name (Sender)* <fill in name> 

Middle Name (Sender) <fill in name, optional>

Last Name (Sender)* <fill in name>

Suffix (Sender) <choose one, optional>

Country(Sender)* <choose one, “Choose” default>

Address 1 (Sender) <fill in address, optional>

Address 2 (Sender) <fill in address, optional>

City (Sender)<fill in city, optional>

State (Sender)* <choose state code, REQUIRED if US = Country>

Zip Code (Sender) <fill in zip, optional >

______________________________________________________________

Can you please provide the email address and phone number given to the company for the sender?”
Agent Scripts March 1, 2015 V5.01 

Script # Script Text Comments/Notes 

Telephone (Sender) <fill in phone#, optional>

Email (Sender) <Fill in email address, optional>

<Beginning> button

<Previous> button

<Next> button

63

64 {HL Product = Money Transfer for RECEIVING INFORMATION}

How was the transfer received?

<Drop down or radio button selection, choose ONE> 

___In person or at home?

___Deposited or credited to an account?

Company(Receiving Agent)* <Fill in name>

Country (Receiving Agent)* <choose one, “Choose” default>

Address 1 (Receiving Agent) <fill in address, optional>

Address 2 (Receiving Agent) <fill in address, optional>

City (Receiving Agent) <fill in city, optional>

State (Receiving Agent)* <choose state code, REQUIRED if US = Country>

Zip Code (Receiving Agent) <fill in zip, optional>

{If DEPOSITED OR CREDITED}

Website or Mobile app name (Receiving Agent)? <Text box to fill in URL or app name>

Can you provide the account number? <Fill in account number>

If the consumer is concerned about providing account information: We use unique information about the account to 

verify that we have the right person to provide to the company and to help make sure the company reviews the 

correct account information. The more information you provide, the easier it will be to review and process the 

complaint.

{DYNAMIC, If the Primary Contact or the On Behalf of person are NOT the recipient the name and 

address fields are presented for Agent to complete. Otherwise they are hidden.}

Salutation (Recipient) <choose one, optional>

First Name (Recipient)* <fill in name>

Middle Name (Recipient)<fill in name, optional>

Last Name(Recipient)* <fill in name>

Suffix (Recipient)<choose one, optional>

Country (Recipient)* <choose one>
Agent Scripts March 1, 2015 V5.01 

Script # Script Text Comments/Notes 

Address 1 (Recipient) <fill in address, optional>

Address 2 (Recipient) <fill in address, optional>

City (Recipient) <fill in city, optional>

State (Recipient)* <choose state code, REQUIRED if US = Country>

Zip Code (Recipient) <fill in zip, optional>

Can you please provide the email address and phone number given to the company for the recipient? 

Telephone (Recipient) <fill in phone#, optional>

Email (Recipient) <Fill in email address, optional>

<Beginning> button

<Previous> button

<Next> button

64

65 {DYNAMIC, If High Level Product = Debt collection}

Are you filing this complaint only on behalf of yourself? <select Yes or NO>

{DYNAMIC, If answer to above question is “NO””

We are only able to take Debt collection complaints by phone if you are filing individually. I’d be happy to 

have a debt collection complaint form sent to you by mail. You’ll need to make sure that both you and the 

other party sign the form before returning it to us. 

<Go to Closing> button

<Beginning> button

<Previous> button

<Next> button

65

66 {If High Level Product = Debt collection}

{If sub Product = Payday loan}

Where did you get the payday loan?

<Select “In person / at a store” or “Online”>

If consumers indicate that they applied online but picked up their loan in person, select “In person / at a 
Agent Scripts March 1, 2015 V5.01 

Script # Script Text Comments/Notes 

store”

{Dynamic, if “In person / at a store” selected}

In which state is the store located? <Select US state, dropdown list>

If the consumer asks why we need this information, say: ”This is important because different states have 

different laws for payday loans.”

{Dynamic, if “Online” selected}

What is the website you used to apply for the payday loan?

<Fill in web URL>

 

What company is contacting you about this debt?* <Fill in company name> 

Enter the company name provided by the consumer. If there is an exact match, you may select from the 

list. Otherwise, enter the full name as provided by the consumer.

If caller does not know name of debt collection company, click on the 'Unknown Company' button <Company 

Unknown button>

If caller says company is the Department of Education or Federal Student Aid, click on the 'Department of Education' 

button.<Dept. of Education> button

{Dynamic, appears if the company is unknown}

Since you don’t know the name of the company we will be unable to send this complaint to a company. 

All complaints will be used to help the CFPB understand consumers’ experiences and monitor providers 

of financial products and services. If you are able to identify the company that is contacting you in the next 

30 days, you can provide that information by calling us.

{Dynamic, appears if company is NOT “unknown”}

Do you have an address for this company?

Address 1 <fill in address, optional>

Address 2 <fill in address, optional>

City <fill in city, optional>

State <fill in state from drop down menu, optional>

ZIP code <fill in zip code+4, optional>

Country <fill in country from drop down menu, United States if default)

{Dynamic, appears only if the Issue=Communications tactics and the sub-issue is the 1

st , 2nd or 5th in 

the sub issue list}
Agent Scripts March 1, 2015 V5.01 

Script # Script Text Comments/Notes 

What phone number are they calling? <fill in caller’s phone # called by debt collector>

This is the caller’s phone number that the debt collector is dialing.

Can you provide a phone number the company is calling you from?

<fill in phone number, optional>

{Dynamic, appears if one phone number is provided}

Is there a second phone number that they’ve called you from?

<fill in phone number, optional> 

This phone number is the number that appears in the caller ID on a phone or may have been provided by 

the company.

Do you know the name or ID # of the debt collection company’s representative who you’ve spoken to?

<fill in name, optional>

Do you have an account number used by the debt collector when they contact you?

<fill in account number, optional>

May I have the last 4 digits of your Social Security Number?

<Enter SSN(4)>

Do you know where this debt came from?

<Same company>button

<Different company> button

<I don’t know> button

If caller is confused by the above question, say “We want to know if the people contacting you were hired 

by another company to collect their debts. If your debt has come from a different company, we'll give you 

the option to file two complaints about your issue: one complaint with the debt collector and a second 

complaint with the company that owns the debt. If you don't know where the debt came from, you should 

select the "I don't know" option.”

<Beginning> button

<Previous> button

<Next> button

66

-routing67 {If High Level Product = Debt collection and “do you know where debt came from?” = Different Company 

(in S#66)}
Agent Scripts March 1, 2015 V5.01 

Script # Script Text Comments/Notes 

What is the name of the original creditor company?* <Fill in company name> 

Enter the company name provided by the consumer. If there is an exact match, you may select from the 

list. Otherwise, enter the full name as provided by the consumer.

If caller does not know name of debt collection company, click on the 'Unknown Company' button <Company 

Unknown button>

If caller says company is the Department of Education or Federal Student Aid, click on the 'Department of Education' 

button.<Dept of ED> button

{Dynamic, appears if the company is unknown}

Since you don’t know the name of the company we will use your complaint to help the CFPB understand 

consumers’ experiences and monitor providers of financial products and services. If you are able to 

identify the creditor in next 30 days, you can provide that information by calling us.

 

Do you want to submit a complaint against this company too?* <Select YES or NO>

If the caller is confused by the above question: “The original creditor company name will be sent to the 

company contacting you about your debt to help their investigation. If you answer “Yes” to this question, 

CFPB will also send the complaint to the original creditor you provided.”

 

{Dynamic, appears only if the caller want to submit a complaint against the original creditor}

{Dynamic, appears if company is NOT “unknown”}

Do you have an address for this company?

Address 1 <fill in address, optional>

Address 2 <fill in address, optional>

City <fill in city, optional>

State <fill in state from drop down menu, optional>

ZIP code <fill in zip code+4, optional>

Country <fill in country from drop down menu, United States if default)

If they are calling you, can you provide a phone number the company is calling you from?

<fill in phone number, optional>

{Dynamic, appears if one phone number is provided}

Is there a second phone number that they’ve called you from?

<fill in phone number, optional> 

This phone number is the number that appears in the caller ID on a phone or may have been provided by 
Agent Scripts March 1, 2015 V5.01 

Script # Script Text Comments/Notes 

the company.

Do you know the name or ID # of the original creditor company’s representative who you’ve spoken to?

<fill in name, optional>

Do you have an account number assigned by the original creditor? 

<fill in account number, optional>

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68 {If HL Product = Credit reporting & caller wants to file a complaint (S#3 response= Complaint)}

Unfortunately we cannot take your complaint by phone at this time. In order to work on your credit 

reporting complaint, we need your permission to have access to your credit report. We’ll only use your 

credit report to work on your complaint, but we can’t get started until we have your permission to get it. 

Do you have access to the Internet? <click on YES or NO button>

 

{Dynamic }

If YES: 

You can complete the form on our website consumerfinance.gov. Once it is submitted, we will process the 

complaint

If NO:

I can mail you a complaint form and a consent form.

Please fill out the forms and send them back to us via fax at (855) 237-2392 or mail it to us at: 

Consumer Financial Protection Bureau 

P.O. Box 4503 

Iowa City, Iowa 52244

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68