Information Collection

Charter Conversions

IC 209409 under ICR 201311-3133-003 · OMB 3133-0015.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3133-0015 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form NCUA 4000 Conversion of State Charter to Federal Charter Charter Conversions	Form and Instruction
Form NCUA 4221 Notice of Meeting of Members to Convert from a Federal to a State Chartered Credit Union Charter Conversions	Form
Form NCUA 4401 Application to Convert from a State to a Federal Credit Union Charter Conversions	Form and Instruction
Form NCUA 4505 Affidavit - Proof of Results of Membership Vote -- Proposed Conversion from a Federal Credit Union to State Credit Union Charter Conversions	Form
Form NCUA 4506 Federal to State Conversion Ballot for Conversion Proposal Charter Conversions	Form
Form NCUA 9500 Application and Agreements for Insurance of Accounts Charter Conversions	Form
Form NCUA 9501 Certification of Resolutions Charter Conversions	Form
Form NCUA 9600 Information to be Provided in Support of the Application of a State Chartered Credit Union for Insurance of Accounts Charter Conversions	Form and Instruction
NCUA 4000 Conversion of State Charter to Federal Charter NCUA_4000-IC 5 of 3133-0015.pdf www.ncua.gov/Legal/GuidesEtc/Pages/Chartering-Manual.aspx	Form and Instruction
NCUA 4221 Notice of Meeting of Members to Convert from a Federal t NCUA_4221-IC 5 of 3133-0015.pdf www.ncua.gov/Legal/GuidesEtc/Pages/Chartering-Manual.aspx	Form
NCUA 4401 Application to Convert from a State to a Federal Credit NCUA_4401-IC 5 of 3133-0015.pdf www.ncua.gov/Legal/GuidesEtc/Pages/Chartering-Manual.aspx	Form and Instruction
NCUA 4505 Affidavit - Proof of Results of Membership Vote -- Propo NCUA_4505-IC 5 of 3133-0015.pdf www.ncua.gov/Legal/GuidesEtc/Pages/Chartering-Manual.aspx	Form
NCUA 4506 Federal to State Conversion Ballot for Conversion Propos NCUA_4506-IC 5 of 3133-0015.pdf www.ncua.gov/Legal/GuidesEtc/Pages/Chartering-Manual.aspx	Form
NCUA 9500 Application and Agreements for Insurance of Accounts NCUA_9500-IC 5 of 3133-0015.pdf www.ncua.gov/Legal/GuidesEtc/Pages/Chartering-Manual.aspx	Form
NCUA 9501 Certification of Resolutions NCUA_9501-IC 5 of 3133-0015.pdf www.ncua.gov/Legal/GuidesEtc/Pages/Chartering-Manual.aspx	Form
NCUA 9600 Information to be Provided in Support of the Application NCUA_9600-IC 5 of 3133-0015.pdf www.ncua.gov/Legal/GuidesEtc/Pages/Chartering-Manual.aspx	Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Charter Conversions

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Mandatory

CFR Citation: 12 CFR 701

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	NCUA 4000	Conversion of State Charter to Federal Charter	NCUA_4000-IC 5 of 3133-0015.pdf	http://www.ncua.gov/Legal/GuidesEtc/Pages/Chartering-Manual.aspx	Yes	Yes	Fillable Fileable Signable
Form	NCUA 4221	Notice of Meeting of Members to Convert from a Federal to a State Chartered Credit Union	NCUA_4221-IC 5 of 3133-0015.pdf	http://www.ncua.gov/Legal/GuidesEtc/Pages/Chartering-Manual.aspx	Yes	Yes	Fillable Fileable Signable
Form and Instruction	NCUA 4401	Application to Convert from a State to a Federal Credit Union	NCUA_4401-IC 5 of 3133-0015.pdf	http://www.ncua.gov/Legal/GuidesEtc/Pages/Chartering-Manual.aspx	Yes	Yes	Fillable Fileable Signable
Form	NCUA 4505	Affidavit - Proof of Results of Membership Vote -- Proposed Conversion from a Federal Credit Union to State Credit Union	NCUA_4505-IC 5 of 3133-0015.pdf	http://www.ncua.gov/Legal/GuidesEtc/Pages/Chartering-Manual.aspx	Yes	Yes	Fillable Fileable
Form	NCUA 4506	Federal to State Conversion Ballot for Conversion Proposal	NCUA_4506-IC 5 of 3133-0015.pdf	http://www.ncua.gov/Legal/GuidesEtc/Pages/Chartering-Manual.aspx	Yes	Yes	Fillable Fileable Signable
Form	NCUA 9500	Application and Agreements for Insurance of Accounts	NCUA_9500-IC 5 of 3133-0015.pdf	http://www.ncua.gov/Legal/GuidesEtc/Pages/Chartering-Manual.aspx	Yes	Yes	Fillable Fileable
Form	NCUA 9501	Certification of Resolutions	NCUA_9501-IC 5 of 3133-0015.pdf	http://www.ncua.gov/Legal/GuidesEtc/Pages/Chartering-Manual.aspx	Yes	Yes	Fillable Fileable
Form and Instruction	NCUA 9600	Information to be Provided in Support of the Application of a State Chartered Credit Union for Insurance of Accounts	NCUA_9600-IC 5 of 3133-0015.pdf	http://www.ncua.gov/Legal/GuidesEtc/Pages/Chartering-Manual.aspx	Yes	Yes	Fillable Fileable Signable

Federal Enterprise Architecture Business Reference Module

Line of Business: Economic Development

Subfunction: Business and Industry Development

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 13

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 90 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	13	13
Annual IC Time Burden (Hours)	520	520
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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