REPORT ON OWNERSHIP OF THE REPORTING BANK AND ON INDEBTEDNESS OF ITS EXECUTIVE OFFICERS AND PRINCIPAL SHAREHOLDERS TO THE REPORTING BANK AND TO ITS CORRESPONDENT
ICR 198104-3064-023
OMB: 3064-0023
Federal Form Document
⚠️ Notice: This information collection may be outdated. More recent filings for OMB 3064-0023 can be found here:
REPORT ON OWNERSHIP OF THE
REPORTING BANK AND ON INDEBTEDNESS OF ITS EXECUTIVE OFFICERS AND
PRINCIPAL SHAREHOLDERS TO THE REPORTING BANK AND TO ITS
CORRESPONDENT
BANKS USE FORM 003 TO REPORT AGGREGATE
INDEBTEDNESS OF INSIDERS TO BOTH THEIR OWN BANK AND CORRESPONDENT
BANKS. FORM 004 IS USED BY INDIVIDUAL INSIDERS TO REPORT THEIR
INDEBTEDNESS TO CORRESPONDENT BANKS. FORM 003 IS SENT TO FDIC AND
IS AVAILABLE TO PUBLIC. FORM 004 IS RETAINED BY BANK.
On behalf of this Federal agency, I certify that
the collection of information encompassed by this request complies
with 5 CFR 1320.9 and the related provisions of 5 CFR
1320.8(b)(3).
The following is a summary of the topics, regarding
the proposed collection of information, that the certification
covers:
(i) Why the information is being collected;
(ii) Use of information;
(iii) Burden estimate;
(iv) Nature of response (voluntary, required for a
benefit, or mandatory);
(v) Nature and extent of confidentiality; and
(vi) Need to display currently valid OMB control
number;
If you are unable to certify compliance with any of
these provisions, identify the item by leaving the box unchecked
and explain the reason in the Supporting Statement.