Information Collection

Form 4063 completed by credit union staff (Notice of Change in Official or Senior Executive Officer)

IC 32746 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⚠️ Notice: This information collection may be referencing outdated material.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 4063 Form 4063 completed by credit union staff (Notice of Change in Official or Senior Executive Officer)	Form and Instruction
4063 Notice of Change in Official or Senior Executive Officer Form4063NoticeofChangeofOfficialorSeniorExecutiveOfficerFINAL.docx	Form and Instruction

IC Title:

Form 4063 completed by credit union staff (Notice of Change in Official or Senior Executive Officer)

Agency IC Tracking Number:

4063

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 12 CFR 701.14

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	4063	Notice of Change in Official or Senior Executive Officer	Form4063NoticeofChangeofOfficialorSeniorExecutiveOfficerFINAL.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	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	424	-226	650
Annual IC Time Burden (Hours)	848	-1,752	2,600
Annual IC Cost Burden (Dollars)	26,763	26,763	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.