Form Independent Direct Independent Direct Federal Home Loan Bank Independent Director Application

FEDERAL HOME LOAN BANK INDEPENDENT DIRECTOR APPLICATION FORM (REVISED)
INSTRUCTIONS
You either have expressed interest in, or have been recommended for, nomination to stand for election
as an independent director of the Federal Home Loan Bank of [TO BE COMPLETED BY EACH BANK]
(Bank). If you would like the Bank’s board of directors to consider you as a possible nominee for an
independent directorship, you must complete and execute this Federal Home Loan Bank Independent
Director Application Form and submit it to the Bank on or before [DATE AT LEAST 30 DAYS AFTER
BANKS PROVIDES ACCESS TO THE FORM]. If you do not submit a completed and executed Form by that
date, you will be deemed to have declined to be considered for nomination.
By law, the Bank’s board of directors may nominate you for an independent directorship only if it has
verified that you meet the legal eligibility requirements applying to independent directors and possess
the professional qualifications that are specified by law for the type of independent directorship for
which you are being considered. Your responses to the questions on this Form will assist the Bank in
verifying that you are legally eligible, and possess the required professional qualifications, to serve as an
independent director of the Bank if elected.
You are eligible to serve as an independent director of the Bank only if you meet all of the following
requirements:
•

You are a citizen of the United States.

•

You are a bona fide resident of the Bank District, as determined by meeting either one of the
following two sets of criteria:
o Your principal residence is located in the Bank District; or
o You both:
 Own or lease in your own name a residence in the Bank District; and
 Are employed in a voting state in the Bank District.

•

Neither you nor your spouse are:
o An officer of any Federal Home Loan Bank; or
o An officer, employee, or director of any member of, or recipient of advances from, the
Bank. For purposes of this prohibition:
 “Advances” includes any form of lending, regardless of whether it is
denominated as an “advance”; and
 “Member” and “recipient of advances” include the institution itself and the
institution’s holding company, except where the assets of all members or all
recipients of advances constitute less than 35 percent of the assets of the
holding company, on a consolidated basis.

These eligibility requirements may be found in sections 7(a) and (b) of the Federal Home Loan Bank Act
(Bank Act), 12 U.S.C. 1427(a) and (b), and in FHFA’s regulations at 12 CFR 1261.5(c) and 1261.10.
In addition, you must demonstrate that you possess certain professional qualifications, which differ
depending on whether you are seeking nomination for a “regular” or a “public interest” independent
directorship. By law, the Bank must designate at least two of the independent directorships on its board
as “public interest” directorships. These may be filled only by individuals having, at the time of

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FEDERAL HOME LOAN BANK INDEPENDENT DIRECTOR APPLICATION FORM (REVISED)
nomination, more than four (4) years of experience representing consumer or community interests in
banking services, credit needs, housing, or consumer financial protections.
Regular independent directorships—that is, those that are not public interest directorships—must be
filled by individuals having, at the time of nomination, experience in or knowledge of one or more of the
following areas: auditing and accounting, derivatives, financial management, organizational
management, project development, risk management practices, and the law. Such knowledge or
experience must be commensurate with that needed to oversee a financial institution with a size and
complexity comparable to that of the Bank. The requirements regarding professional qualifications may
be found in section 7(a)(3)(B) of the Bank Act, 12 U.S.C. 1427(a)(3)(B), and in FHFA’s regulations at 12
CFR 1261.7(e).
Please answer all applicable questions in full and do not answer any question by referring to another
document, except where expressly permitted to do so. You may continue your answers onto additional
pages, if necessary, each of which shall be attached to, and deemed a part of, this Form.
YOUR PERSONAL INFORMATION
Please provide your personal information as indicated in Questions 1 – 4.
1. Full Name:
2. Other Names Currently or Formerly Used, or Known by:
3. Contact Information:
•
•
•

Phone number (leave room for multiple; indicate home, office, or cell):
E-mail address:
Mailing address: Number/Street (or PO Box), City, State, Zip Code

4. Current Employment, if Applicable:
•
•
•

Current employer:
Your title or position:
Address of your place of employment: Number/Street, City, State, Zip Code

ELIGIBILITY REQUIREMENTS
Please answer Questions 5 – 8, regarding your eligibility to serve as an independent director, in full.
CITIZENSHIP AND RESIDENCY
You must meet the legal requirements as to U.S. citizenship and Bank District residency to be eligible
for nomination for an independent directorship.
5. Citizenship. Are you a citizen of the United States? ___ Yes ___ No
6. Residency.
A. Do you own or lease a residence within the Bank District? ___ Yes ___ No
If you answered No to Question 6A, you do not meet the residency requirement.
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FEDERAL HOME LOAN BANK INDEPENDENT DIRECTOR APPLICATION FORM (REVISED)
B. If you answered Yes to Question 6A, please provide the street address of your residence
within the Bank District: (Number/Street, City, State, Zip Code)
C. Is the address provided in response to Question 6B your principal residence?
___ Yes ___ No
If you answered Yes to Question 6C, you meet the residency requirement.
If you answered No to Question 6C, you may still meet the residency requirement if you
are employed within the Bank District. Please continue with Question 6D to indicate
your in-District employment status.
D. Are you employed within the Bank District? ___ Yes ___ No
E. If you answered Yes to Question 6D, please identify your in-District employer:
o
o

___ Check if your in-District employment information is the same as that
entered in response to Question 4.
___ Check if your in-District employment information is different from that
entered in response to Question 4, then provide the following information:
 Name of your in-District employer:
 Your title or position:
 Address of your place of employment: Number/Street, City, State,
Zip Code

INDEPENDENCE
The information you provide below will enable the Bank to determine whether you meet the
independence requirements. You may be nominated if you do not currently meet the
independence requirements, but you must agree as part of the certification at the end of this Form
that you and your spouse will relinquish any positions that the Bank determines to be prohibited
under those requirements. If elected, you may not be seated as an independent director so long as
you or your spouse hold any such prohibited positions and, once seated, would become ineligible to
continue to serve as an independent director if you or your spouse were to take any such prohibited
positions.
7. Employment by a Federal Home Loan Bank.
A. Are you or your spouse an officer or employee of any Federal Home Loan Bank?
___ Yes ___ No
B. If you answered Yes to Question 7A, please provide the following information for each
such position held by you or your spouse:
o Name of the person holding the position:
o Federal Home Loan Bank of:
o Title or position:
o Dates held:
8. Employment by a Bank Member, Housing Associate, or Holding Company.
A. Are you or your spouse an officer, director, or employee of a member of the Bank, an
entity certified as a housing associate of the Bank, or a holding company that controls
one or more members or housing associates of the Bank? ___ Yes ___ No
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FEDERAL HOME LOAN BANK INDEPENDENT DIRECTOR APPLICATION FORM (REVISED)
B. If you answered Yes to Question 8A, please provide the following information for each
such position held by you or your spouse:
o
o
o

o
o
o

Name of the person holding the position:
Name of the employer:
Check the appropriate response below to indicate whether the employer is:
 ___ a member
 ___ a holding company of a member
 ___ a housing associate
 ___ a holding company of a housing associate
Title or position:
Dates held:
If the employer is a holding company:
 Indicate the total assets of the holding company;
 Indicate the total assets of each member or housing associate of the
Bank controlled by the holding company; and
 Provide, or direct the Bank to, documentation to support those
amounts.

ACADEMIC AND EMPLOYMENT HISTORY
Please answer in full Questions 9 - 11, regarding your academic and employment background. If you
wish, you may answer any or all of these questions by attaching a resume or CV, so long as you provide
all of the information requested. Any such attachments shall be deemed a part of this Form.
•

___ Check if you have attached a resume or CV in response to Questions 9 - 11.

9. Academic Degrees. Please list any college or advanced academic degrees that you have been
awarded, specifying for each: the type of degree, the name and location of the academic
institution that awarded your degree, and the date awarded.
10. Employment History. Please list, from most to least recent, the positions you have held during
your professional career, specifying for each: the name and location of your employer, your
position, and the date range (including month and year) during which you served in that
position. Please explain any major gaps in your employment chronology.
11. Other Relevant Experience and Achievements. Please list any other significant positions you
have held, or currently hold, (such as other directorships or volunteer positions) and any
professional certifications that you believe are relevant to your qualifications to serve as an
independent director of the Bank, specifying for each: the name and location of the
organization with which you served, your position, and the date range during which you served
in that position; for each certification, list the certification name, the certifying entity, and the
date of your certification.

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FEDERAL HOME LOAN BANK INDEPENDENT DIRECTOR APPLICATION FORM (REVISED)
PROFESSIONAL QUALIFICATIONS
Please indicate in response to Question 12 whether you are seeking nomination for a public interest
independent directorship or a regular independent directorship and then complete the appropriate
questions regarding your qualifications for that type of independent directorship. If you wish to be
considered for both types of independent directorships, or are unsure, please check both options. If you
wish to be considered for a public interest independent directorship, you must answer Question 13 in
full. If you wish to be considered for a regular independent directorship, you must answer Questions 14
– 15 in full. If you wish to be considered for only one type of independent directorship, you are not
required to answer the question or questions pertaining to the other type, although you may choose to
do so if you wish to highlight relevant knowledge or experience in the areas addressed in those
questions.
12. Type of Independent Directorship Being Sought. Please check one of the boxes below to
indicate the type of independent directorship you are seeking.
•

___ Check if you are seeking a public interest independent directorship.

•

___ Check if you are seeking a regular independent directorship.

PUBLIC INTEREST INDEPENDENT DIRECTORSHIP
By statute, a nominee for a public interest independent directorship must have “more than 4 years of
experience in representing consumer or community interests on banking services, credit needs, housing,
or consumer financial protections.” Qualifying experience in one of the four enumerated areas may
have been acquired in professional, public service, or volunteer positions, so long as the work done was
substantial in terms of time commitment and responsibility. As indicated by the statute’s use of the
word “representing,” the experience must have involved advocating for, or otherwise acting primarily
for the direct benefit of, consumer or community interests in one of the four enumerated areas.
Further, the experience must accrue from activities personally undertaken by the individual seeking
nomination as a public interest independent director, as opposed to being attributed based solely on
the activities of an organization with which the person was associated. Please reach out to the Bank if
you have questions as to whether your experience meets the statutory requirements to qualify for
service as a public interest independent director.
13. Representation of Consumer and Community Interests. Please explain in detail how you have
represented consumer or community interests in banking services, credit needs, housing, or
consumer financial protections for more than four years. At a minimum:
•
•
•
•

Identify the positions through which you obtained your qualifying experience and
specify the dates during which you served in those positions.
Specify whether those positions involved banking services, credit needs, housing, or
consumer financial protections.
To the extent that your experience was obtained with an organization or agency,
describe generally the mission of each such organization or agency and the manner in
which its mission is typically fulfilled.
Describe your responsibilities in those positions and, if any were not full-time paid
employment, indicate the amount of time you spent fulfilling those responsibilities
annually.

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FEDERAL HOME LOAN BANK INDEPENDENT DIRECTOR APPLICATION FORM (REVISED)
•

Describe your major accomplishments in those positions that relate to the experience
needed to qualify as a public interest independent director.

REGULAR INDEPENDENT DIRECTORSHIP
If you are seeking a regular independent directorship, please answer in full Questions 14 – 15, which
pertain to your professional qualifications to serve in that capacity. If you are seeking a public interest
independent directorship, you are not required to answer these questions, but may choose to do so if
you possess relevant knowledge and experience that you wish to highlight.
14. Primary Areas of Knowledge and Experience. Please indicate below, by checking the
appropriate boxes, the professional areas in which you have significant knowledge or experience
that is commensurate with that needed to oversee a financial institution with a size and
complexity comparable to that of the Bank.
•

___ Auditing and accounting

•

___ Derivatives

•

___ Financial management

•

___ Organizational management

•

___ Project development

•

___ Risk management practices

•

___ The law

15. Description of Knowledge and Experience. For each of your primary areas of professional
knowledge and experience indicated in response to Question 14, please describe in detail the
nature of that knowledge and experience and the circumstances under which you obtained it.
At a minimum, for each area:
•

Identify the entities with which you were employed or otherwise associated when you
gained the knowledge or experience and describe briefly the business or mission of
those entities (e.g., “investment bank,” “law firm,” etc.).

•

Identify the positions you have held with those entities and describe your major
accomplishments in those positions with respect to the relevant areas.

OTHER MATTERS
16. Personal Integrity. Is there anything in your background that might cause a reasonable person
to question your personal integrity, your ability to fulfill the fiduciary duties of a board director,
or your competence to supervise the management of the Bank (issues of concern could include,
but are not limited to: past felony convictions or pending felony charges; any findings by a court
or administrative body that you have violated federal or state civil laws relating to securities,
banking, housing, or real estate; suspension or revocation of a professional license; a personal
or business bankruptcy filing; a foreclosure action; or having been the subject of a tax lien)?
___ Yes ___ No
If you answered Yes, please fully describe the incidents, the timeframes in which they occurred,
and their ultimate disposition and provide supporting documentation where appropriate.

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FEDERAL HOME LOAN BANK INDEPENDENT DIRECTOR APPLICATION FORM (REVISED)
17. Conflicts of Interest. Other than any relationships described in response to Questions 7 – 8, do
you or, to your knowledge, do any of your immediate family members (i.e., a parent, sibling,
spouse, child, other dependent, or any relative sharing your residence) or close business
associates (i.e., a corporation or organization of which you are an officer or a partner, or in
which you own more than ten percent of any class of equity security (including subordinated
debt); an individual that is an officer or a partner of, or who owns more than ten percent of any
class of equity security (including subordinated debt) in, such a corporation or organization; or a
trust in which you have a substantial interest or serve in a fiduciary capacity) have any financial
interests or other relationships that might create actual or apparent conflicts of interest or
might otherwise lead a reasonable person to question your ability to administer the affairs of
the Bank fairly and impartially? ___ Yes ___ No
If you answered Yes, please fully describe the nature of those interests or relationships, the
individuals or entities involved, and their relationship to you.
By executing this Form, you are certifying that:
•
•
•
•

The information you have provided is true, correct, and complete to the best of your
knowledge;
You acknowledge that the Bank and the Federal Housing Finance Agency may perform a
background check on you, including without limitation regarding any information disclosed
herein;
You understand that you have a continuing obligation to inform the Bank of any facts that
may call into question your eligibility or ability to serve as a Bank director; and
If you are nominated and elected to serve as a director:
o You and your spouse will relinquish any positions that the Bank determines to be
prohibited by the statutory and regulatory independence requirements for
independent directors; and
o You will regularly attend the meetings of the board of directors and the board
committees to which you are assigned and will devote the time necessary to
adequately prepare for those meetings and execute your other responsibilities as an
independent director.

Signature:

Dated:

Privacy Act Statement: In accordance with the Privacy Act (5 U.S.C. 552a), the following notice is
provided. This information is solicited under authority of 12 U.S.C. 1427(a) and (b) and 12 CFR 1261.5,
1261.7, and 1261.10 to 1261.13. Furnishing the information on this Form is voluntary, but failure to do
so may result in your not meeting the statutory and regulatory eligibility requirements to serve as a
Federal Home Loan Bank independent director. The purpose of this information is to facilitate the
timely determination of your eligibility to serve as an independent director. Information may be
disclosed in accordance with the routine uses identified in FHFA-System of Records Notice FHFA-8
Federal Home Loan Bank Directors, which may be found at

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FEDERAL HOME LOAN BANK INDEPENDENT DIRECTOR APPLICATION FORM (REVISED)
https://www.fhfa.gov/AboutUs/FOIAPrivacy/Documents/SORNs/FHFA8%20Federal%20Home%20Loan%20Bank%20Directors.pdf.
Paperwork Reduction Act Statement: Notwithstanding any other provision of the law, no person is
required to respond to, nor shall any person be subject to a penalty for failure to comply with, a
collection of information subject to the requirements of the Paperwork Reduction Act, unless that
collection of information displays a currently valid OMB Control Number.
OMB No. 2590-0006
Expires ##/##/20##

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