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⚠️ Notice: This information collection may be referencing outdated material.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

Document Name Document Type
Form NCUA 4000 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:

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 %

	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

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.