Information Collection

Monthly Sample (federal) Monthly Sample (state)

IC 176121 under ICR 197707-3133-003 · OMB 3133-0001.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3133-0001 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type

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IC Title:

MONTHLY SAMPLE (FEDERAL) MONTHLY SAMPLE (STATE)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Migrated

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	NCUA 5301				No	No
Form	NCUA 5303				No	No

Line of Business:

Subfunction:

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 12,000

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	12,000	12,000
Annual IC Time Burden (Hours)	2,000	2,000
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.