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⚠️ Notice: This information collection may be referencing outdated material.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

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

Information Collection (IC) Details

View Information Collection (IC)

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:

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 %

	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

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.