NCUA 15503 Interagency Appraisal Complaint Form

NCUA CAC

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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 regulator's 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);
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.
Submit

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OMB# 3133-XXXX

Interagency Appraisal Complaint Form

Your Information

Required Fields
First Name

Last Name

Email

Phone Number

Address

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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
Lender

Appraisal Management Company
--None--

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NCUA CAC

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Are you employed by the subject of
your complaint?
Other
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,Business)

Phone

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Address, City, State, Zip Code

What is the nature of your complaint? Check all that apply.

Appraiser independence

Appraisal fee-related issue

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 report inaccurate

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Other

Please provide information about your complaint.

Type of property

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--None--

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Address of the Property Involved
At what company or government
agency?

Have you tried to resolve your
complaint with anyone?
If Yes, date of contact
Who did you contact?

Describe your complaint.

Briefly describe your complaint. Do not submit any documents with your
complaint. You will be contacted if more information is needed.

Submit

Cancel

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--None--

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[ 1/16/2018 ]