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Chartering and Field of Membership Manual
Chartering and Field of Membership Manual, 12 CFR 701.1, App. B to Part 701
OMB: 3133-0015
IC ID: 32675
OMB.report
NCUA
OMB 3133-0015
ICR 201708-3133-001
IC 32675
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3133-0015 can be found here:
2021-12-28 - Revision of a currently approved collection
2021-01-29 - Revision of a currently approved collection
Documents and Forms
Document Name
Document Type
Form 4001
Chartering and Field of Membership Manual
Form and Instruction
NCUA 4008 Organization Certification
NCUA_4008.pdf
www.ncua.gov/Legal/GuidesEtc/CharteringAndFOMForms/NCUA_4008.pdf
Form
NCUA 4012 Report of Official and Agreement to Serve
NCUA_4012.pdf
www.ncua.gov/Legal/GuidesEtc/CharteringAndFOMForms/NCUA_4012.pdf
Form
NCUA 9500 Application and Agreements for Insurance of Accounts
NCUA_9500.pdf
www.ncua.gov/Legal/GuidesEtc/CharteringAndFOMForms/NCUA_9500.pdf
Form
NCUA 9501 Certification of Resolutions
NCUA_9501.pdf
www.ncua.gov/Legal/GuidesEtc/CharteringAndFOMForms/NCUA_9501.pdf
Form
NCUA 4015 Application FOM Amendment (Multiple Common Bond Expansio
NCUA_4015.pdf
www.ncua.gov/Legal/GuidesEtc/CharteringAndFOMForms/NCUA_4015.pdf
Form
NCUA 4015-EZ Application FOM Amendment (Multiple Common Bond Expansio
NCUA_4015-EZ.pdf
www.ncua.gov/Legal/GuidesEtc/CharteringAndFOMForms/NCUA_4015EZ.pdf
Form
NCUA 4015-A Application FOM Amendment (Multiple Common Bond Expansio
NCUA_4015-A.pdf
Form
NCUA 4000 Conversions of State Charter to Federal Charter (FCU Inv
NCUA_4000.pdf
www.ncua.gov/Legal/GuidesEtc/CharteringAndFOMForms/NCUA_4000.pdf
Form
NCUA 4221 Notice of Meeting of Members to Convert from a Federal t
NCUA_4221.pdf
www.ncua.gov/Legal/GuidesEtc/CharteringAndFOMForms/NCUA_4221.pdf
Form
NCUA 4401 Application to Convert From a State to a Federal CU
NCUA_4401.pdf
www.ncua.gov/Legal/GuidesEtc/CharteringAndFOMForms/NCUA_4401.pdf
Form
NCUA 4505 Affidavit - Proof of Results Membership Vote
NCUA_4505.pdf
www.ncua.gov/Legal/GuidesEtc/CharteringAndFOMForms/NCUA_4505.pdf
Form
NCUA 4506 Federal to State Conversion - Ballot for Conversion Prop
NCUA_4506.pdf
www.ncua.gov/Legal/GuidesEtc/CharteringAndFOMForms/NCUA_4506.pdf
Form
4001 FCU Investigation Report
NCUA_4001.pdf
www.ncua.gov/Legal/GuidesEtc/CharteringAndFOMForms/NCUA_4001.pdf
Form and Instruction
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Chartering and Field of Membership Manual
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Unchanged
Obligation to Respond:
Mandatory
CFR Citation:
12 CFR 701
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form and Instruction
4001
FCU Investigation Report
NCUA_4001.pdf
https://www.ncua.gov/Legal/GuidesEtc/CharteringAndFOMForms/NCUA_4001.pdf
Yes
No
Fillable Printable
Form
NCUA 4008
Organization Certification
NCUA_4008.pdf
https://www.ncua.gov/Legal/GuidesEtc/CharteringAndFOMForms/NCUA_4008.pdf
Yes
No
Fillable Printable
Form
NCUA 4012
Report of Official and Agreement to Serve
NCUA_4012.pdf
https://www.ncua.gov/Legal/GuidesEtc/CharteringAndFOMForms/NCUA_4012.pdf
Yes
No
Fillable Printable
Form
NCUA 9500
Application and Agreements for Insurance of Accounts
NCUA_9500.pdf
https://www.ncua.gov/Legal/GuidesEtc/CharteringAndFOMForms/NCUA_9500.pdf
Yes
No
Fillable Printable
Form
NCUA 9501
Certification of Resolutions
NCUA_9501.pdf
https://www.ncua.gov/Legal/GuidesEtc/CharteringAndFOMForms/NCUA_9501.pdf
Yes
No
Fillable Printable
Form
NCUA 4015
Application FOM Amendment (Multiple Common Bond Expansion Groups of 3,000 or more)
NCUA_4015.pdf
https://www.ncua.gov/Legal/GuidesEtc/CharteringAndFOMForms/NCUA_4015.pdf
Yes
No
Fillable Printable
Form
NCUA 4015-EZ
Application FOM Amendment (Multiple Common Bond Expansions less than 3,000 and All Single Common Bond Expansions)
NCUA_4015-EZ.pdf
https://www.ncua.gov/Legal/GuidesEtc/CharteringAndFOMForms/NCUA_4015EZ.pdf
Yes
No
Fillable Printable
Form
NCUA 4015-A
Application FOM Amendment (Multiple Common Bond Expansion Groups of 3,000 to 4,999)
NCUA_4015-A.pdf
Yes
No
Fillable Printable
Form
NCUA 4000
Conversions of State Charter to Federal Charter (FCU Investigation Report)
NCUA_4000.pdf
https://www.ncua.gov/Legal/GuidesEtc/CharteringAndFOMForms/NCUA_4000.pdf
Yes
No
Fillable Printable
Form
NCUA 4221
Notice of Meeting of Members to Convert from a Federal to a State Chartered CU
NCUA_4221.pdf
https://www.ncua.gov/Legal/GuidesEtc/CharteringAndFOMForms/NCUA_4221.pdf
Yes
No
Fillable Printable
Form
NCUA 4401
Application to Convert From a State to a Federal CU
NCUA_4401.pdf
https://www.ncua.gov/Legal/GuidesEtc/CharteringAndFOMForms/NCUA_4401.pdf
Yes
No
Fillable Printable
Form
NCUA 4505
Affidavit - Proof of Results Membership Vote
NCUA_4505.pdf
https://www.ncua.gov/Legal/GuidesEtc/CharteringAndFOMForms/NCUA_4505.pdf
Yes
No
Fillable Printable
Form
NCUA 4506
Federal to State Conversion - Ballot for Conversion Proposal
NCUA_4506.pdf
https://www.ncua.gov/Legal/GuidesEtc/CharteringAndFOMForms/NCUA_4506.pdf
Yes
No
Fillable Printable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Economic Development
Subfunction:
Business and Industry Development
Privacy Act System of Records
Title:
Personnel Access and Security System (PASS)
FR Citation:
81 FR 12748
Number of Respondents:
8,052
Number of Respondents for Small Entity:
0
Affected Public:
Private Sector
Private Sector:
Not-for-profit institutions
Percentage of Respondents Reporting Electronically:
90 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
9,215
0
1,090
8,123
0
2
Annual IC Time Burden (Hours)
40,223
0
26,160
13,743
0
320
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
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.