Information Collection

Form 4063a - Individual Application for Approval of Official or Senior Executive Officer

IC 217772 under ICR 202109-3133-002 · OMB 3133-0121.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3133-0121 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 4062a Form 4063a - Individual Application for Approval of Official or Senior Executive Officer	Form and Instruction
4062a Individual Application for Approval of Official or Senio NCUA_4063a_Individual_App_Official-SrExe_SEP2015(1).pdf	Form and Instruction
4062a Individual Application for Approval of Official or Senio NCUA_4063a_Individual_App_Official-SrExe_SEP2015(1).pdf	Form and Instruction

IC Title:

Form 4063a - Individual Application for Approval of Official or Senior Executive Officer

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 12 CFR 701.14

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 and Instruction	4062a	Individual Application for Approval of Official or Senior Executive Officer	NCUA_4063a_Individual_App_Official-SrExe_SEP2015(1).pdf		Yes	Yes	Fillable Fileable

Line of Business: Economic Development

Subfunction: Financial Sector Oversight

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 183

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 80 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	183	-36	219
Annual IC Time Burden (Hours)	366	-72	438
Annual IC Cost Burden (Dollars)	0	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.