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Charter Conversions
Chartering and Field of Membership Manual, 12 CFR 701.1, App. B to Part 701
OMB: 3133-0015
IC ID: 209409
OMB.report
NCUA
OMB 3133-0015
ICR 201311-3133-003
IC 209409
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3133-0015 can be found here:
2021-12-28 - Revision of a currently approved collection
2021-01-29 - Revision of a currently approved collection
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 New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
13
0
13
0
0
0
Annual IC Time Burden (Hours)
520
0
520
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
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.