FR 2572

OMB No. 3170-0001

Average hours per response: 0.25

Approval expires June 30, 2013

As of:

mmddyyyy

1. Name of credit card plan: Name of contact:

(Limit to 36 characters) Title of contact:

2. Availability of credit card plan (enter code): 1 Phone number of contact: Institution Name 1 = National 2 = Regional 3 = One State 2 E-Mail of contact:

3 3

Credit Card Plan Information By State: PLEASE READ INSTRUCTIONS BEFORE COMPLETING FORM

3. National

4. Regional

5. AL

6. AK

7. AZ

8. AR

9. CA

10. CO

11. CT

12. DE

13. DC

14. FL

15. GA

16. HI

17. ID

18. IL

19. IN

20. IA

21. KS

22. KY

23. LA

24. ME

25. MD

State

APR

Percent

A

Dollars

B

Dollars

E

Dollars Dollars

L

(Code)*

M

Percent

N

To

TERMS FOR FOURTH TIER

APR Balance Range

From To

Dollars

K

From To

Balance Range

From

Dollars

I

Percent

J

TERMS FOR THIRD TIER

APR Balance Range

From

Percent

G

Dollars

H

VARIABLE RATE

Index Margin Multiple

F

To

TERMS FOR SECOND TIER

Balance Range

Dollars

C

Percent

D

APR

Annual 

Fee

Grace 

Period

(Days)

Q

Dollars

R

Number

O

Dollars

P

Percent

U

Transaction Fee for 

Purchases

Minimum Finance 

Charge

Percent

S

Dollars

T

REPORT OF TERMS OF CREDIT CARD PLANS

This report is required by law [15 U.S.C. § 1646(b)].

* Variable rate index codes: 1 = Prime, 2 = One-month T-bill, 3 = Three-month T-bill, 4 = Six-month T-bill, 5 = One-year T-bill, 6 = Fed Funds, 7 = Cost of Funds, 8 = Federal Reserve Discount Rate, 9 = Other.

(enter 10 digits, no 

formatting)
CFPB 3170-0001

Page 2 of 3

26. MA

27. MI

28. MN

29. MS

30. MO

31. MT

32. NE

33. NV

34. NH

35. NJ

36. NM

37. NY

38. NC

39. ND

40. OH

41. OK

42. OR

43. PA

44. RI

45. SC

46. SD

47. TN

48. TX

49. UT

50. VT

51. VA

52. WA

53. WV

54. WI

55. WY

56. Transaction fee for cash advances: 58. Over the credit limit fee:

If fee is uniform over the plan's region, identify amount: If fee is uniform over the plan's region, identify amount:

Amount A. B. Amount A. B.

Or if fee varies over the plan's region, identify range: Or if fee varies over the plan's region, identify range:

Minimum amount C. D. Minimum amount C. D.

Maximum amount E. F. Maximum amount E. F.

57. Late Payment fee: 1

If fee is uniform over the plan's region, indicate amount: 2

Amount A. B. 3

Or if fee varies over the plan's region, identify range: 4

Minimum amount C. D. 5

Maximum amount E. F. 6

(Days) Dollars Percent Dollars Percent

A B C D E F G H I J K L M N O P Q R S T U

To APR Balance Range APR Balance Range APR Balance Range Index Margin Multiple From To From To From To

Dollars

State

APR

Balance Range TERMS FOR SECOND TIER TERMS FOR THIRD TIER TERMS FOR FOURTH TIER

Percent Dollars Dollars Percent Dollars Dollars Percent Dollars Dollars Percent Dollars Dollars

Dollars Percent Dollars Percent

* Variable rate index codes: 1 = Prime, 2 = One-month T-bill, 3 = Three-month T-bill, 4 = Six-month T-bill, 5 = One-year T-bill, 6 = Fed Funds, 7 = Cost of Funds, 8 = Federal Reserve Discount Rate, 9 = Other.

From

VARIABLE RATE

(Code)* Percent Number

Annual 

Fee

Grace 

Period

Transaction Fee for 

Purchases

Minimum Finance 

Charge
CFPB 3170-0001

Page 3 of 3

7

59. Balance computation method (enter code):

1 = Average daily balance including new purchases; 3 = Two-cycle average daily balance including new purchases;

4 = Two-cycle average daily balance including new purchases; 6 = Previous balance;

7 = Other - please describe (limit to 752 characters).

60. Credit card plan enhancements automatically included in the credit card plan (enter an "X" next to each enhancement offered). (The reporting of this is optional):

1. rebates on purchases; 2. extension of manufacturer's warranty; 3. purchase protection/security;

4. travel accident insurance; 5. travel related discounts; 6. automobile rental insurance;

7. discounts on the purchases of goods and services 8. credit card registration; 9. reduced introductory interest rate available;

(other than travel related);

10. other (do not specify).

61. Name and address to obtain credit card application (limit to 288 characters):

62. Telephone number for consumers with questions about credit card rates and terms (limit to 16 characters):

A toll free number is requested if available: (enter ten digits, no formatting)

2 = Average daily balance excluding new purchases;

5 = Adjusted balance;