Information Collection

Annual Voluntary Credit Union Diversity Self-Assessment

IC 219173 under ICR 202105-3133-001 · 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⚠️ Notice: This information collection may be referencing outdated material.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 15004 Annual Voluntary Credit Union Diversity Self-Assessment	Form
15004 Annual Voluntary Credit Union Diversity Self Assessment FORM 15004 - CUDSA.pdf cudiversity.ncua.gov/Home/Survey	Form
15004 Annual Voluntary Credit Union Diversity Self Assessment FORM 15004 - CUDSA.pdf cudiversity.ncua.gov/Home/Survey	Form

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	15004	Annual Voluntary Credit Union Diversity Self Assessment	FORM 15004 - CUDSA.pdf	https://cudiversity.ncua.gov/Home/Survey	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	Previously Approved
Annual Number of Responses for this IC	325	325
Annual IC Time Burden (Hours)	2,600	2,600
Annual IC Cost Burden (Dollars)	0	0

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.