Notice of Change of Officials and Senior Executive Officers

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 4063 Notice of Change in Official or Senior Executive Officer	Form and Instruction	Modified	Available
Form 4063 Form 4063 - Notice of Change In Official or Senior Executive Officer; Waiver to Notice	Form and Instruction	Modified	Repair queued
Form 4062a Individual Application for Approval of Official or Senior Executive Officer	Form and Instruction	Modified	Available
Form 4062a Form 4063a - Individual Application for Approval of Official or Senior Executive Officer	Form and Instruction	Modified	Repair queued
12CFR701-14_(1-1-21 ED).pdf	Supplementary Document	Uploaded 2021-11-29	Repair queued
Final_3133-0121_SS_EXT_112921.docx	Supporting Statement A	Uploaded 2021-11-29	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
32746	Form 4063 - Notice of Change In Official or Senior Executive Officer; Waiver to Notice	Form and Instruction	Modified	Notice of Change in Official or Senior Executive Officer
32746	Form 4063 - Notice of Change In Official or Senior Executive Officer; Waiver to Notice	Form and Instruction	Modified
217772	Form 4063a - Individual Application for Approval of Official or Senior Executive Officer	Form and Instruction	Modified	Individual Application for Approval of Official or Senior Executive Officer
217772	Form 4063a - Individual Application for Approval of Official or Senior Executive Officer	Form and Instruction	Modified

ICR Details

OMB Control No: 3133-0121	ICR Reference No: 202109-3133-002
Status: Historical Active	Previous ICR Reference No: 201804-3133-001
Agency/Subagency: NCUA	Agency Tracking No: E&I
Title: Notice of Change of Officials and Senior Executive Officers
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 01/11/2022
Retrieve Notice of Action (NOA)	Date Received in OIRA: 11/30/2021
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2025	36 Months From Approved	01/31/2022
Responses	454	0	483
Time Burden (Hours)	759	0	884
Cost Burden (Dollars)	0	0	0

---

Abstract: In order to comply with statutory requirements, the agency must obtain sufficient information from new officials or senior executive officers of troubled or newly chartered credit unions to determine their fitness for the position. This is established by the Financial Institutions Reform, Recovery, and Enforcement Act of 1989 (FIRREA), Pub.L. 101-73. The forms provide a standardize format to collect the information needed.

---

Authorizing Statute(s): PL: Pub.L. 101 - 73 914 Name of Law: Financial Institution Reform, Recovery, and Enforcement Act
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 53352	09/27/2021
30-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 67500	11/26/2021
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 2

table that charts list of burden

IC Title	Form No.	Form Name
Form 4063 - Notice of Change In Official or Senior Executive Officer; Waiver to Notice	4063	Notice of Change in Official or Senior Executive Officer
Form 4063a - Individual Application for Approval of Official or Senior Executive Officer	4062a	Individual Application for Approval of Official or Senior Executive Officer

---

ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	454	483	0	0	-29	0
Annual Time Burden (Hours)	759	884	0	0	-125	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: The estimated burden has decreased since the last submission, due to the decrease in the number of newly chartered and troubled credit unions. A reduction of 125 burden hours is attributed to this adjustment. Total of 759 burden hours are requested.

---

Annual Cost to Federal Government: $72,528

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

---

Common Form ICR:  No

---

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 11/30/2021

---