4501A Profile

CREDIT
UNIONUNION
PROGRAMS
AND MEMBER SERVICES
NATIONAL
CREDIT
ADMINISTRATION
ALEXANDRIA, VIRGINIA 22314-3428
OFFICIAL BUSINESS

Credit Union Profile Form and Instructions
TO THE BOARD OF DIRECTORS OF THE CREDIT UNION ADDRESSED:

This booklet contains the Form 4501A Profile. The effective date of this form is
March 31, XXXX and will remain in effect until superseded. Instructions and
quarterly filing dates for are available on the NCUA’s website at
www.ncua.gov.
The Profile Reporting Instructions page contains the filing requirements. Please
note, the Profile must be certified in conjunction with the filing of the Form 5300
Call Report.
The NCUA website provides the quarterly filing date. In addition, credit union
contacts of record will continue to receive quarterly email notifications of the
cycle highlights.
If you have any questions, please contact your National Credit Union
Administration Regional Office or your state credit union supervisor,
as
Credit
appropriate. Please direct any technical questions to NCUA Customer Service at
1-800-827-3255.

OMB No. 3133-0004

NCUA Profile Form 4501A
Effective March 31, 20XX
Previous Editions Are Obsolete

REPORTING REQUIREMENTS
Provide Updated Information: In accordance with NCUA Rules and Regulations
§741.6(a)(1), insured credit unions are required to update their profile information within
10 days of the election or appointment of senior management and volunteer officials, or
within 30 days of any change.

Records Retention: Credit unions should retain a copy of the information used to
complete the profile as a part of the permanent records of the credit union.

The instructions to prepare this form meet the requirement to provide guidance to small
credit unions under Section 212 of the Small Business Regulatory Enforcement Fairness
Act of 1996.
You are not required to provide the information requested on a form that is subject to the
Paperwork Reduction Act unless the form displays a valid OMB control number.
Public reporting burden of this collection of information is estimated to average 6 hours
per response, including the time for reviewing instructions, searching existing data needed,
and completing and reviewing the collection of information. Send comments regarding
this burden estimate or any other aspects of this collection of information, including
suggestions for reducing this burden to:
National Credit Union Administration
Office of the Chief Information Officer
1775 Duke Street
Alexandria, VA 22314-3428

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NCUA Profile Form 4501A
Effective March 31, 20XX
Previous Editions Are Obsolete

CERTIFICATION
Credit Union Name :

Charter Number :

I understand each operating insured credit union must update their credit union profile within 10 days after the election or
appointment of senior management or volunteer officials, or within 30 days of any change of the information in the profile.
I hereby certify to the best of my knowledge and belief the information provided is current and accurate. I make this certification
pursuant to sections 106, 120, and 204 of the Federal Credit Union Act (12 U.S.C. 1756, 1766, and 1784).
Certified By
Last Name :
Please Print

First Name :

Date :

Certified Correct By

Full Name :
Certified Correct By (Signature)

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NCUA Profile Form 4501A
Effective March 31, 20XX
Previous Editions Are Obsolete

Page 1

CERTIFY COMPLIANCE MINIMUM SECURITY DEVICES AND PROCEDURES
NCUA RULES AND REGULATIONS PART 748
FEDERALLY INSURED CREDIT UNIONS ONLY
Charter Number :

Credit Union Name :

I hereby certify to the best of my knowledge and belief that this credit union has developed and administers a security program
that equals or exceeds the standards prescribed by Part 748 of the NCUA Rules and Regulations; that such security
program has been reduced to writing, approved by this credit union's Board of Directors; and this credit union has provided for
the installation, maintenance, and operation of security devices, if appropriate, in each of its offices. Further, I certify that I am
the president or managing official of the credit union or that the president or managing official has authorized me to make this
submission on his/her behalf.
Certified By
Last Name :
Please Print

First Name :

Date :

Certified By

Job Title :
Please Print

Full Name :
Certified By (Signature)

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NCUA Profile Form 4501A
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Previous Editions Are Obsolete

Page 2

GENERAL INFORMATION

1. Select the type of credit committee the credit union has:
a. Elected

b. Appointed

2. Has your credit union filed a bond claim in the last 12 months?

c. No Committee
a. Yes

b. No

3. Provide the credit union's Employer Identification Number (EIN):
4. Provide the Research Statistics Supervision and Discount (RSSD) ID number
issued by the Board of Governors of the Federal Reserve System (pre populated).

5. Is your credit union a member of the Federal Home Loan Bank?
a. Yes

b. No

6. Has your credit union filed an application to borrow from the Federal Reserve Bank Discount Window?
a. Yes

b. No

7. Has your credit union pre-pledged collateral with the Federal Reserve Bank Discount Window?
a. Yes

OMB No. 3133-0004

b. No

NCUA Profile Form 4501A
Effective March 31, 20XX
Previous Editions Are Obsolete

Page 3

Contacts and Roles
The credit union must provide information for the Mandatory Job Titles and Mandatory Roles listed below. These individuals may be officials,
volunteers, or employees of the credit union. NCUA will not release information regarding mailing addresses, email addresses, phone numbers, and
fax numbers to the public. Please reference the Profile Instructions for additional guidance.

Provide information for the following:
Mandatory Job Titles
Manager or CEO
Board Chairperson
Board Vice Chairperson
Board Treasurer
Board Members

Mandatory Roles

Supervisory Committee Chairperson
Supervisory Committee Members
Credit Committee Chairperson
Credit Committee Members

Call Report Contact
Profile Contact
Primary Emergency Contact
Secondary Emergency Contact

Primary Patriot Act Contact
Secondary Patriot Act Contact
Third Patriot Act Contact (if applicable)
Fourth Patriot Act Contact (if applicable)

1. Salutation*
2. First Name*

4. Last Name*

3. Middle Initial

5. Job Titles - * Indicates the credit union is required to provide information for these mandatory job titles .
a. Manager or CEO*

b. Board Chairperson*

c. Board Vice Chairperson*

d. Board Secretary

e. Board Treasurer*

f. Board Members*

g. Supervisory Committee Chairperson*

h. Supervisory Committee Member*

i. Credit Committee Chairperson, if applicable*

j.

Credit Committee Member, if applicable*

k. Chief Financial Officer

l.

Chief Information Officer

m. Internal Auditor

n. Other

6. Roles - * Indicates the credit union is required to provide information for these mandatory roles .
a. Volunteer

b. General Credit Union Contact

c. Call Report Contact*

d. Profile Information Contact*

e. Primary Patriot Act Contact*

f. Secondary Patriot Act Contact*

g. Third Patriot Act Contact, if applicable*

h. Fourth Patriot Act Contact, if applicable*

i. Primary Emergency Contact*

j.

Secondary Emergency Contact*

k. Credit Union Employee

l.

Information Security Contact

7. Credit Union Employment Type* - The credit union is required to provide the employment type for all Mandatory Job Titles and Roles .
a. Full-time

b.

Part-time

c. Volunteer

8. Home Address Information* - The credit union is required to provide this information for all Mandatory Job Titles
Address Line 1:
Address Line 2:
City

State

Postal Code

Home email:
Home phone:

Home cell:

Home fax:

Home county:

9. Work Address Information - The credit union is required to provide a work phone number for all Mandatory Roles
Work email:
Work phone*:

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Work cell:

NCUA Profile Form 4501A
Effective March 31, 20XX
Previous Editions Are Obsolete

Page 4

SITES
The section of the profile is a mandatory section and must include the following site types and site functions:
Site Types
· Corporate Office
· Branch Office(s)

Site Functions
· Vital Records Center
· Location of Records
· Disaster Recovery

Mandatory fields are identified with an asterisk (*). Please reference the instructions for additional guidance.
1. *Site Name:
2. *Operational Status:

a. Normal

b. Planned

c. Suspended - Emergency

3. *Site Type:

a. Corporate Office

b. Branch Office

c. Other (Please Specify)

4. *Is Main Office:

a. Yes

b. No

5. *Hours of Operation:
6. *Physical Address:

Address Line 1:
Address Line 2:
City / State / Postal Code:
County

7. *Mailing Address:

Country

Address Line 1:
Address Line 2:
City / State / Postal Code:

8. *Phone Numbers:

County

Country

Phone

Extension

Fax
9. *Site Function(s):

Public Site Functions (published in the
online Credit Union Locator)

Non-Public Site Functions
a. Disaster Recovery Location

h. Shared Service Center/Network

b. Location of Records

i. ATM

c. Vital Records Center

j. Drive Thru

d. Backup Generator

k. Member Services

e. Future Office
f. Hot Site
g. Planned Evacuation Site

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NCUA Profile Form 4501A
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Previous Editions Are Obsolete

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PAYMENT SYSTEM SERVICE PROVIDER INFORMATION (PSSP)

1. Select the credit union's Primary Settlement Agent (i.e., Member share draft clearing, ACH transactions, etc. -- See Instructions)
a. Federal Reserve Bank

b. CUSO

c. Corporate Credit Union

d. Federal Credit Union

e. Bank

f. Other Credit Union

g. Not Applicable

2. Provide the name of the primary payment systems service provider.
a. If other was selected, please specify

3. Identify the payment service (s) used by the primary system service provider. (check all that apply)
a. Share Draft Processing and Settlement

b. Credit Card Processing and Settlement

c. Wire Transfers

d. ATM and Debit Processing and Settlement

e. Electronic Funds Transfer and Direct Deposit

f. Other

4. Have you changed payment system providers or plan to within the next 12 months?
a. Yes

b. No

5. Provide the name of the new provider :
6. Identify payment service(s) affected by this change. (check all that apply)
a. Share Draft Processing and Settlement

b. Credit Card Processing and Settlement

c. Wire Transfers

d. ATM and Debit Processing and Settlement

e. Electronic Funds Transfer and Direct Deposit

f. Other

d. CUSO

7. Systems used to process electronic payments (check all that apply)
a. Fedline Advantage

b. Corporate Credit Union

c. Correspondent Bank

e. CHIPS

f. FedWire

g. EPN

h. Other (Please Specify)

8. If the credit union performs ACH transfers, are they domestic, international, or both? (check all that apply):
a. Domestic

b. International

If the credit union is an Originating Depository Financial Institution, what types of ACH transactions are originated by the credit union? (check all that
9. apply):
a. PPD - Prearranged Payment and Deposit Entry

b. WEB - Internet Initiated/Mobile Entry

c. TEL - Telephone Initiated Entry

d. IAT - International ACH Transactions

e. Other Consumer Entry Codes

f. Other Business Entry Codes

10. If the credit union performs wire transfers, are they domestic, international, or both? (check all that apply):
a. Domestic

b. International

11. Which method(s) can a member use to initiate electronic payments (e.g. wire transfer, ACH, etc.) from the credit union (check all that apply):
a. Email

b. Fax

c. Online Banking

d. Telephone

e. In Person

f. Other (Please Specify)

Repeat Questions 1-3 for each Settlement Agent used.

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NCUA Profile Form 4501A
Effective March 31, 20XX
Previous Editions Are Obsolete

Page 6

INFORMATION TECHNOLOGY (IT)

1. Does the credit union have a website?

a. Yes

b. No

a. Internal

b. External

a. Informational Website

b. Online Banking

a. Website Address :

2. Where is the website hosted ?
3. Provide the name of the external website vendor :
4. Select the type(s) service offered :

c. Mobile Application

5. If a credit union has online or mobile banking, how many members use it?
6. Which wireless networks, if any, does the credit union operate:
a. Public or Guest Network

b. Private or Restricted Network

7. Data Processing System used to maintain credit union records :
a. Manual System

b. Vendor Supplied In-House System

c. Vendor Online Service Bureau

d. CU Developed In-house System

8. If the credit union has undergone or plans to undergo a Core Data Processing Conversion, please provide the following:
a. Date of Conversion:
b. Core Processor Converting/Converted to:

9. Name of the primary share/loan data processing vendor :
10. Select the service(s) the credit union offers electronically:
a. Account Aggregation

b. Bill Payment

c. Download Account History

d. Electronic Signature Auth./Cert.

e. E-Statements

f. External Account Transfers

g. Loan Payments

h. Member Application

i. Merchant Processing

j. New Loan

k. New Share Account

l. Remote Deposit Capture

m. Mobile Payments

n. Other (Please Specify)

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NCUA Profile Form 4501A
Effective March 31, 20XX
Previous Editions Are Obsolete

Page 7

REGULATORY INFORMATION

1. Please provide the date of the most recent annual meeting held by the credit union:
2. Please provide the date of the most recent supervisory committee or financial statement audit:
3. Please select the last type of audit performed:
a. Financial statement audit performed by state licensed persons
b. Balance sheet audit performed by state licensed persons
c. Examinations of internal controls over call reporting performed by state licensed persons
d. Supervisory Committee audit performed by state licensed persons
e. Supervisory Committee audit performed by other external auditors
f. Supervisory Committee audit performed by the supervisory committee or designated staff

4. Provide the name of the Audit Firm or Auditor (see instructions)
5. Please provide the effective date of the most recent Supervisory Committee verification of member's accounts :
6. Please select who completed the verification of member's accounts:
a. Supervisory Committee

b. Third Party

7. Provide your Supervisory Committee contact information for official correspondence
Mailing Address:_________________________________________ Email:____________________
Mailing City:_______________________________ State:___________ Zip Code:_______________
8. Provide the date of the most recent Bank Secrecy Act Independent Test:
9. Indicate the Fidelity Bond Provider Name :
10. Indicate the amount of Fidelity Coverage for any Single Loss (RR 713.5):
11. Does your credit union maintain share/deposit insurance coverage other than the NCUSIF?

a. Yes

b. No

(Do not include Life Savings and Borrowers' Protection insurance or Surety Bond coverage.)
a. If yes, please provide the name of the insurance company
b. If yes, please provide the dollar amount of shares and/or deposits insured by the company named above

12. Please provide Section 701.4 certification date (Federal Credit Unions Only):
Certification Date

13. Please provide Section 701.4 certifier's name (Federal Credit Unions Only):
Certified By

14. Please provide Section 701.4 certifier's job title (Federal Credit Unions Only):
Job Title

15. Does your credit union meet any of the following criteria?

a. Yes

b. No

- Credit union with 100 or more employees; or
- Credit union with 50 or more employees and:
1) Has a contract of at least $50,000 with the Federal government; or
2) Serves as a depository of U.S. government funds of any amount; or
3) Serves as a paying agent for U.S. Savings Bonds.
a. If yes, what is the last date (MM/DD/YYYY) you filed an EEO-1 Report with the EEOC?
b. If yes, do you have a diversity policy and/or program in your credit union?

a. Yes

b. No

16. List any trade names the credit union uses for signage or advertising.

OMB No. 3133-0004

NCUA Profile Form 4501A
Effective March 31, 20XX
Previous Editions Are Obsolete

Page 8

DISASTER RECOVERY INFORMATION

1. In the event of a disaster, will the credit union communicate with members through a website ?
a. Yes

b. No

2. Please check the resources or services you have available and would be willing to share with other credit unions
during the time of an emergency if you did not need them. (Check all that apply)
a. Cash Non-Member Share Drafts

b. IT Support

c. Office Space

d. Generator

e. Mobile Branch

f. Staff/Management Services

3. Please provide the date of the last disaster recovery test completed by the credit union :
a. Indicate the method(s) used for the last disaster recovery test completed by the credit union.

OMB No. 3133-0004

1. Orientation/Walk Through

3. Functional Testing

2. Tabletop/Mini-Drill

4. Full-Scale Testing

NCUA Profile Form 4501A
Effective March 31, 20XX
Previous Editions Are Obsolete

Page 9

CREDIT UNION PROGRAMS AND MEMBER SERVICES

1. Credit Union Programs (Check all that apply)
a. Mortgage Processing

b. Deposits and Shares Meeting 703.10(a)

c. Approved Mortgage Seller

d. Brokered Certificates of Deposit

e. Brokered Deposits (all deposits acquired through a third party)

f. Investment Pilot Program (FCU Only)

2. Member Service and Product Offerings (Check all that apply)
Financial Literacy Education

Consumer Initiated Remittance Transfers

a. Financial Counseling

a. International Remittances

b. Financial Education

b. Low-cost Wire Transfers

c. Financial Literacy Workshops

c. Proprietary remittance transfer services operated by the CU

d. First Time Homebuyer Program

d. Proprietary remittance transfer services operated by another person

e. Credit Management and Repair
f. Online Financial Literacy

In-School Branches (If checked, specify number of branches)
a. Elementary School

Other Member Services and Products

b. Middle School

a. No Cost Share Drafts

c. High School

b. No Cost Bill Payer
c. No Cost Tax Preparation Services

Youth Savings Accounts/Programs

d. Share Certificates with low minimum balance requirement

a. Offer Custodial Accounts

e. Student Scholarship

b. Offer Non-Custodial Accounts

f. Credit Builder
g. Bilingual Services

3. Shared Service Centers/Networks

a. Yes

b. No

4. Payday Alternative Loans (PAL loans) program (FCUs Only) - Place a "" in the associated box for all the credit union offers (Check all that app
a. Credit Bureau Reporting
b. Financial Education
c. Forced Savings Component
d. Payroll Deduction

5. Minority Depository Institution Questions
Are more than 50% of your credit union’s current and eligible potential members Black American, Native American, Hispanic American, or Asian
American? If yes, please identify the minority group(s) that apply:
a. Black American

b. Hispanic American

c. Native American

d. Asian American

Is more than 50% of your credit union’s board of directors Black American, Native American, Hispanic American, or Asian American? If yes, please
identify the minority group(s) that apply:
a. Black American

b. Hispanic American

c. Native American

d. Asian American

OMB No. 3133-0004

NCUA Profile Form 4501A
Effective March 31, 20XX
Previous Editions Are Obsolete

Page 10

CREDIT UNION GRANT INFORMATION
This page must be completed if the credit union received grant funds.
Please provide information on any grants you have received since the last time you reported.

Grantor Type and Grantor
Date Awarded

Amount
Awarded

Received
YTD

Grant Type*

Government Agency or Affiliate
Community Development Financial Institution
Department of Education
Department of Health and Human Services
Federal Home Loan Bank
Housing and Urban Development
Internal Revenue Service
NCUA Technical Assistance Program
Small Business Administration
US Department of Agriculture
Other (Please Specify):
Other (Please Specify):

Trade Associations
National Credit Union Foundation
National Federation of Community Development Credit Unions
State League Foundation
Other (Please Specify):

Credit Unions and Banks
Specify Name:
Specify Name:

Foundations (local and national)
Specify Name:
Specify Name:
*Grant Types:

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a. Capital - unrestricted donation to equity

c. Program Grant

b. Subsidy for Risk or ALLL

d. Pass Through

NCUA Profile Form 4501A
Effective Mach 31, 20XX
Previous Editions Are Obsolete

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MERGER PARTNER REGISTRY

This page is optional for credit unions. The information contained in this section will not be released to the public. Mandatory
fields are identified with an asterisk (*).
1. Is your credit union interested in expanding its field of membership through a consolidation (If Yes, Please proceed to the remaining
questions)?
a. Yes

b. No

2. Please provide the name and phone number of the person at the credit union who can be contacted regarding any potential consolidations.
*Job Title :
*First Name :

*Last Name :

*Phone :

*Extension :

3. Please identify the geographic areas in which the credit union would be interested. (Select only ONE Box)
Anywhere in the United States
Anywhere within Selected States (Please specify states)

Specific Counties/Cities within Selected State(s)
State

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County/Counties

NCUA Profile Form 4501A
Effective March 31, 20XX
Previous Editions Are Obsolete

City/Cities

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