Form 3133-0188 Interagency Appraisal Form

Interagency Appraisal Complaint Form

	Purpose: This form collects information about complaints of non-compliance with the appraisal independence standards and the Uniform Standards of Professional Appraisal Practice, including complaints from appraisers, individuals, financial institutions, and other entities. Complaint Process: Your complaint will be reviewed by the appropriate regulator(s). Please do not submit documents with your complaint, as the regulator(s) will contact you if more information is needed. Please note the regulator(s) may not be able to provide the resolution you request because of legal and other constraints. For example, regulator(s) considering a complaint do not have jurisdiction to directly award damages, settle fee disputes, or act as your attorney or expert witness. A regulator’s review of your complaint will focus on potential violations of applicable law or regulatory policy and could result in a regulator taking action(s) against the entity about which you are complaining. Paperwork Reduction Act of 1995: The burden for this collection of information is estimated to take 30 minutes per response. This includes time for reviewing the instructions, gathering needed information, and completing and reviewing the form. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. If you have comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, send comments to: Legislative and Regulatory Activities Division, Office of the Comptroller of the Currency, Washington, DC 20219; Comments/Legal ESS, Federal Deposit Insurance Corporation, 550 17th Street NW, Washington, DC 20429; NCUA PRA, National Credit Union Administration, 1775 Duke Street, Alexandria, Virginia 22314. Privacy Notice: The information you are providing is being collected pursuant to the individual authorities of the federal financial institution regulators (12 U.S.C. §§ 1, 481, 1464, 1756, 1766, and 1820 in connection with a complaint made pursuant to 12 U.S.C. § 3351(i). The information provided will be used to ensure the appropriate regulator receives your compliant and by the regulator to review and respond to your complaint. In order to review and respond to your complaint, the appropriate regulator may disclose your information consistent with the routine uses listed in the regulators’ respective Privacy Act statements: OCC (www.helpwithmybank.gov/policies/policies-privacy.html); FDIC (www.fdic.gov/consumers/questions/Priv_statement.html); FRB (www.federalreserve.gov/privacy.htm); and NCUA (www.mycreditunion.gov/Pages/privacy.aspx). Do not include any information in your complaint you consider confidential or do not want disclosed during the complaint review process. While completing this form is voluntary, failure to provide all of the information may delay or prevent the appropriate regulator from reviewing your complaint. Whistleblowers: Federal and state laws offer protection for whistleblowers.
	Your Information
	________________________________________________________ (_____) _____-________ Name (First, Last or Business) Phone ______________________________________________ __________________________ Address, City, State, Zip Code Email
Who are you? Please check the appropriate box.
Individual Property Owner Mortgage Broker Business Property Owner Appraiser Financial Institution Lender Appraisal Management Company Non-Financial Institution Lender Other __________________________
Who are you complaining about? Check all that apply.
Appraiser i Appraisal Management Company Lenderr Other __________________________ Are you employed by the subject of your complaint? Yes No
Please provide information regarding the person or entity you are complaining about. If more than one, please provide information in the “Describe your complaint” section, below.
_______________________________________________________ (_____) _____-________ Name (First, Last or Business) Phone _____________________________________________________________________________ Address, City, State, Zip Code
What is the nature of your complaint? Check all that apply.
Appraiser independence Non-compliance with Uniform Standards of Professional Appraisal Practice Improper (or attempted improper) influencing of an appraiser or the appraisal process Removal or exclusion from an approved appraiser list or addition to a “do not use” list Appraisal fee-related issue Appraisal report inaccurate Other_____________________________________________________________________
Please provide information about your complaint
Type of Property Residential 1-to-4 Family Commercial or Multi-Family (over 4 units)		Address of the Property Involved _______________________________ _______________________________
Have you tried to resolve your complaint with anyone? Yes No If Yes, date of contact: _______________ Who did you contact? ________________________ At what company or government agency? ____________________________________________
Describe your complaint
Briefly describe your complaint. Do not submit any documents with your complaint. You will be contacted if more information is needed. ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________
For more information on appraiser independence or the Uniform Standards of Professional Appraisal Practice (USPAP), go to: www.ReferMyAppraisalComplaint.gov.

­­­­­­­­­­­­­­­­­­­­I certify that I am the named individual or business (or their designee) filing this complaint and the information in this complaint is true and correct to the best of my knowledge and belief.

___________________________________­­­­­______ ______________________________

Signature Date

OMB #3133-0188 Exp. 05/31/2017