Information Collection

Form 4063a - Individual Application for Approval of Official or Senior Executive Officer

IC 217772 under ICR 201804-3133-001 · 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⚠️ Notice: This information collection may be referencing outdated material.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

Document Name Document Type
Form 4062a Form 4063a - Individual Application for Approval of Official or Senior Executive Officer Form and Instruction
4062a Individual Application for Approval of Official or Senio NCUA_4063a_Individual_App_Official-SrExe_SEP2015(1).pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Form 4063a - Individual Application for Approval of Official or Senior Executive Officer	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 12 CFR 701.14

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	4062a	Individual Application for Approval of Official or Senior Executive Officer	NCUA_4063a_Individual_App_Official-SrExe_SEP2015(1).pdf		Yes	Yes	Fillable Fileable

Line of Business: Economic Development

Subfunction: Financial Sector Oversight

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 219	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 80 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	219	-205	424
Annual IC Time Burden (Hours)	438	-410	848
Annual IC Cost Burden (Dollars)	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.