Information Collection

Annual Voluntary Credit Union Diversity Self-Assessment

IC 219173 under ICR 201805-3133-002 · OMB 3133-0193.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3133-0193 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form NCUA 15004 Annual Voluntary Credit Union Diversity Self-Assessment	Form and Instruction
NCUA 15004 Annual Voluntary Credit Union Diversity Self-Assessment NCUA 15004_JUN18.pdf	Form and Instruction

IC Title:

Annual Voluntary Credit Union Diversity Self-Assessment

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

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	NCUA 15004	Annual Voluntary Credit Union Diversity Self-Assessment	NCUA 15004_JUN18.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: 325

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	325	0	-42	367
Annual IC Time Burden (Hours)	2,600	-1,300	-504	4,404
Annual IC Cost Burden (Dollars)	0	0	-409,572	409,572

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.