1558 Notice to Establish a Branch Office or for Change of Loc

OMB No. 1550-0006
Expiration Date: 12/31/2006

OFFICE OF THRIFT SUPERVISION
NOTICE TO ESTABLISH A BRANCH OFFICE OR FOR CHANGE OF LOCATION OF
AN EXISTING OFFICE OR FOR REDESIGNATION OF A HOME OR BRANCH
OFFICE
PAPERWORK REDUCTION ACT STATEMENT
The Office of Thrift Supervision (OTS) will use this information to approve a federally-chartered
institution’s proposal to establish a branch or change the location of an existing branch office and to
determine if the federally-chartered institution qualifies for expedited processing treatment of its
application. 12 C.F.R. § 545.92 requires federally-chartered institutions to file an application with OTS.
Collection of the information is mandatory.
Public report burden for this collection of information is estimated to average 10 minutes per response,
including the time for reviewing instructions and completing and reviewing the collection of information.
If a valid OMB Control Number does not appear on this form, you are not required to complete this form.
Send comments regarding this burden estimate or any other aspect of the collection of information,
including suggestions for reducing this burden, to Office of Thrift Supervision, Examinations and
Supervision, 1700 G Street, N.W., Washington, D.C. 20552; and to the Office of Management and
Budget, Paperwork Reduction Project (1550-0006), Washington, D.C. 20503.

Page 1 of 3
OTS Form 1558
Revised March 2004

OMB No. 1550-0006
Expiration Date: 12/31/2006

Docket Number:_______________

OFFICE OF THRIFT SUPERVISION
NOTICE TO ESTABLISH A BRANCH OFFICE OR FOR CHANGE OF LOCATION OF AN
EXISTING OFFICE OR FOR REDESIGNATION OF A HOME OR BRANCH OFFICE
TO: Office of Thrift Supervision

Date of Notice ___________________

We, the undersigned executive officer and secretary, pursuant to the resolution of a majority of the members of the
board of directors of:
____________________________________________________________________________________________
Savings Institution Name
____________________________________________________________________________________________
Street Address of Savings Institution (include City, State, and Zip Code)
(hereinafter the Institution), hereby provide notice to the Office of Thrift Supervision (OTS) that the Institution
intends, within 12 months of the date of this notice, to establish a branch office or change the location of an office,
or to redesignate a home or branch office, pursuant to 12 C.F.R. §§ 545.92, 545.93, and 545.95:
____________________________________________________________________________________________
New address of branch office (if unable to provide exact address, inform Regional Office of the address at opening
date)
____________________________________________________________________________________________
Present address of branch office, if a change of location is involved
We, the undersigned, do hereby certify:
1.
2.
3.

4.
5.
6.
7.

8.

That, to the best of our belief, the Institution qualifies for expedited treatment, pursuant to 12 C.F.R.
§ 516.5;
That the Institution will abide by all related rules, regulations, and guidance issued by OTS;
That we are aware that OTS may request additional information, or may impose conditions, or may
determine that the establishment or change of locations or home office redesignation does not comply with
the requirements of 12 C.F.R. §§ 545.92, 545.93, or 545.95;
That the Institution is aware of the publication of notice requirements, pursuant to 12 C.F.R.
§ 545.92(d)(1), and that the Institution has published notices in accordance with regulations;
That if a protest based on 12 C.F.R. Part 563e is filed, the branch office may not open until OTS provides
notice of its approval;
That the Institution has attached any additional information required pursuant to 12 C.F.R. §§ 545.92,
545.93, and 545.95, and any public comment letters received;
That the proposal will not negatively affect the quality of the human environment by changes in air and/or
water quality, noise levels, energy consumption, congestion of population, solid waste disposal, or
environmental integrity of private land within the meaning of the National Environmental Policy Act, 42
U.S.C. 4321, et seq.; and
That the proposal will not affect any historical district, site, building, structure, object, or archaeological
site listed in, or eligible for inclusion in, the National Register of Historic Places, pursuant to the National
Historic Preservation Act, 16 U.S.C. 470f. (As appropriate, provide a copy of any documentation of
consultation with the SHPO or THPO.)
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OTS Form 1558
Revised March 2004

OMB No. 1550-0006
Expiration Date: 12/31/2006

______________________________________
Executive Officer

___________________________________
Secretary
___________________________________
Date of Receipt by OTS

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OTS Form 1558
Revised March 2004