Involuntary Liquidation Proof of Claim Form

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form NCUA: 7250 Proof of Claim Form	Form and Instruction	New	Available
Supporting Statement Proof of Claim Form 3133-NEW_FINAL.docx	Supporting Statement A	Uploaded 2015-01-15	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
214534	Supplemental Evidence for Proof of Claim	Other-Supplementary Evidence Requirements	New
214533	Proof of Claim Form	Form and Instruction	New

ICR Details

OMB Control No: 3133-0192	ICR Reference No: 201501-3133-001
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: NCUA	Agency Tracking No:
Title: Involuntary Liquidation Proof of Claim Form
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 09/14/2015
	Date Received in OIRA: 01/23/2015
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2018	36 Months From Approved
Responses	220	0	0
Time Burden (Hours)	220	0	0
Cost Burden (Dollars)	11,000	0	0

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Abstract: In accordance with the 12 C.F.R. Part 709, the National Credit Union Administration (NCUA) is appointed liquidating agent of a credit union when the credit union is placed into involuntary liquidation. 12 C.F.R. Part 709.6 instructs creditors to present a written claim to the liquidating agent by the date specified in the notice to creditors. The collection of information requirement is that those creditors making a claim must document their claim in writing and submit a form to the liquidating agent. In addition, the liquidating agent may require a claimant to submit supplemental evidence to support its claim. This collection of information is necessary to protect the National Credit Union Share Insurance Fund in determining valid claims.

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Authorizing Statute(s): US Code: 12 USC 1787(b) Name of Law: The Federal Credit Union Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 34555	06/17/2014
30-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 3259	01/22/2015
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 2

table that charts list of burden

IC Title	Form No.	Form Name
Proof of Claim Form	NCUA: 7250	Proof Of Claim
Supplemental Evidence for Proof of Claim

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	220	0	0	220	0	0
Annual Time Burden (Hours)	220	0	0	220	0	0
Annual Cost Burden (Dollars)	11,000	0	0	11,000	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Changing Regulations

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: There is no change in burden because this is a new collection.

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Annual Cost to Federal Government: $1,250

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 01/23/2015

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