Notice of Change of Officials and Senior Executive Officers

Forms and Documents

Document Name	Status
Form 4063 Form 4063 completed by credit union staff (Notice of Change in Official or Senior Executive Officer) Form and Instruction	Modified
Form 4063a Form 4063a completed by credit union staff (Individual Application for Approval of Official or Senior Executive Officer) Form and Instruction	New
3133-0121 SSChangeofOfficialsandSeniorExecutivesFINAL.docx Supporting Statement A	2015-09-18

IC Document Collections

IC ID	Document Title	Status
32746	Form 4063 completed by credit union staff (Notice of Change in Official or Senior Executive Officer) Form and Instruction	Modified
217777	Printing and mailing activities	New
217776	Information collection to file a reconsideration or appeal	New
217775	Information collection to provide additional information	New
217772	Form 4063a completed by credit union staff (Individual Application for Approval of Official or Senior Executive Officer) Form and Instruction	New

ICR Details

OMB Control No: 3133-0121	ICR Reference No: 201505-3133-004
Status: Historical Active	Previous ICR Reference No: 201107-3133-001
Agency/Subagency: NCUA	Agency Tracking No:
Title: Notice of Change of Officials and Senior Executive Officers
Type of Information Collection: Reinstatement with change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 09/21/2015
	Date Received in OIRA: 08/05/2015
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2018	36 Months From Approved
Responses	2,034	0	0
Time Burden (Hours)	1,907	0	0
Cost Burden (Dollars)	34,948	0	0

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Abstract: In order to comply with statutory requirements, the agency must obtain sufficient information from new officials or senior executive officers of troubled or newly chartered credit unions (CU's) to determine their fitness for the position. This is established by the Financial Institutions Reform, Recovery, and Enforcement Act of 1989. These forms standardize the information gathered to evaluate the individual's fitness for the position. The format is similar to the one used by the FFIEC agencies and FRB.

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Authorizing Statute(s): PL: Pub.L. 101 - 73 914 Name of Law: Financial Institution Reform, Recovery, and Enforcement 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:
	80 FR 3255	01/22/2015
30-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 30498	05/28/2015
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 5

IC Title	Form No.	Form Name
Form 4063 completed by credit union staff (Notice of Change in Official or Senior Executive Officer)	4063	Notice of Change in Official or Senior Executive Officer
Form 4063a completed by credit union staff (Individual Application for Approval of Official or Senior Executive Officer)	4063a	Individual Application for Approval of Official or Senior Executive Officer
Printing and mailing activities
Information collection to provide additional information
Information collection to file a reconsideration or appeal

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ICR Summary 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	2,034	0	0	1,384	0	650
Annual Time Burden (Hours)	1,907	0	0	-693	0	2,600
Annual Cost Burden (Dollars)	34,948	0	0	34,948	0	0

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

Burden Increase Due to: Miscellaneous Actions

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

Burden Reduction Due to: Miscellaneous Actions

Short Statement: The estimated burden has decreased since the last submission, due to the decrease in the number of troubled credit unions.

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Annual Cost to Federal Government: $159,560

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: 08/05/2015

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