Information Collection

Form 4063a completed by credit union staff (Individual Application for Approval of Official or Senior Executive Officer)

IC 217772 under ICR 201505-3133-004 · OMB 3133-0121.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3133-0121 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 4063a Form 4063a completed by credit union staff (Individual Application for Approval of Official or Senior Executive Officer)	Form and Instruction
4063a Individual Application for Approval of Official or Senio Form4063a_IndividualApplicationforApprovalofOfficialorSeniorExecutiveOfficerFINAL.docx	Form and Instruction

IC Title:

Form 4063a completed by credit union staff (Individual Application for Approval of Official or Senior Executive Officer)

Agency IC Tracking Number:

4063a

Is this a Common Form? No

IC Status: New

Obligation to Respond: Mandatory

CFR Citation: 12 CFR 701.14 12 CFR 741.205

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	4063a	Individual Application for Approval of Official or Senior Executive Officer	Form4063a_IndividualApplicationforApprovalofOfficialorSeniorExecutiveOfficerFINAL.docx		Yes	Yes	Fillable Fileable Signable

Line of Business: Economic Development

Subfunction: Financial Sector Oversight

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 424

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 80 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	424	424
Annual IC Time Burden (Hours)	848	848
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.