Information Collection

Notice of Change in Official or Senior Executive Officer (Form 4063)

IC 32746 under ICR 201107-3133-001 · OMB 3133-0121.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3133-0121 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 4063 Notice of Change in Official or Senior Executive Officer (Form 4063)	Form and Instruction
4063 Notice of Change in Official or Senior Executive Officer new0121 4063Notice of Change Form.pdf	Form and Instruction
4063a Individual Application for Approval of Official or Senio new0121 4063aApproval of Official Form.pdf	Form and Instruction
3133-0121Supplemental Document.docx Comment Statement	IC Document

IC Title:

Notice of Change in Official or Senior Executive Officer (Form 4063)

Agency IC Tracking Number:

4063-4063a

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 12 CFR 701.14

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 and Instruction	4063	Notice of Change in Official or Senior Executive Officer	new0121 4063Notice of Change Form.pdf		Yes	No	Fillable Fileable
Form and Instruction	4063a	Individual Application for Approval of Official or Senior Executive Officer	new0121 4063aApproval of Official Form.pdf		Yes	No	Fillable Fileable

Line of Business: Economic Development

Subfunction: Financial Sector Oversight

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 650

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	650	388	262
Annual IC Time Burden (Hours)	2,600	2,076	524
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Comment Statement	3133-0121Supplemental Document.docx	08/10/2011

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