Form NCUA 15003 NCUA 15003 Interagency Appraisal Complaint 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 (NCUA: OMB Control No. 3133-XXXX). 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: National Credit Union Administration, Attn: PRA
Clearance Officer, 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
B_______________________________________________________ (_____) _____-________
Name (First, Last or Business)
Phone
______________________________________________
Address, City, State, Zip Code

__________________________
Email

Who are you? Please check the appropriate box.
Individual Property Owner
Business Property Owner
Financial Institution Lender
Non-Financial Institution Lender

Mortgage Broker
Appraiser
Appraisal Management Company
Other __________________________

Who are you complaining about? Check all that apply.
Appraiser i
Appraisal Management Company
Lenderr
Other __________________________
Yes
No
Are you employed by the subject of your complaint?
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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
Address of the Property Involved
_______________________________
Residential 1-to-4 Family
Commercial or Multi-Family (over 4 units)
_______________________________
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
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______________________________
Date