Information Collection

Chartering and Field of Membership Manual

IC 32675 under ICR 202111-3133-002 · OMB 3133-0015.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3133-0015 can be found here:

2024-12-16 - Revision of a currently approved collection

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form NCUA 4008 Chartering and Field of Membership Manual	Form
NCUA 4008 Organization Certification NCUA_4008.pdf www.ncua.gov/Legal/GuidesEtc/CharteringAndFOMForms/NCUA_4008.pdf	Form
NCUA 4008 Organization Certification NCUA_4008.pdf www.ncua.gov/Legal/GuidesEtc/CharteringAndFOMForms/NCUA_4008.pdf	Form
NCUA 4012 Report of Official and Agreement to Serve NCUA_4012.pdf www.ncua.gov/Legal/GuidesEtc/CharteringAndFOMForms/NCUA_4012.pdf	Form
NCUA 4012 Report of Official and Agreement to Serve NCUA_4012.pdf www.ncua.gov/Legal/GuidesEtc/CharteringAndFOMForms/NCUA_4012.pdf	Form
NCUA 9500 Application and Agreements for Insurance of Accounts NCUA_9500.pdf www.ncua.gov/Legal/GuidesEtc/CharteringAndFOMForms/NCUA_9500.pdf	Form
NCUA 9500 Application and Agreements for Insurance of Accounts NCUA_9500.pdf www.ncua.gov/Legal/GuidesEtc/CharteringAndFOMForms/NCUA_9500.pdf	Form
NCUA 9501 Certification of Resolutions NCUA_9501.pdf www.ncua.gov/Legal/GuidesEtc/CharteringAndFOMForms/NCUA_9501.pdf	Form
NCUA 9501 Certification of Resolutions NCUA_9501.pdf www.ncua.gov/Legal/GuidesEtc/CharteringAndFOMForms/NCUA_9501.pdf	Form
NCUA 4015 Application FOM Amendment (Multiple Common Bond Expansio NCUA_4015.pdf www.ncua.gov/Legal/GuidesEtc/CharteringAndFOMForms/NCUA_4015.pdf	Form
NCUA 4015 Application FOM Amendment (Multiple Common Bond Expansio NCUA_4015.pdf www.ncua.gov/Legal/GuidesEtc/CharteringAndFOMForms/NCUA_4015.pdf	Form
NCUA 4015-EZ Application FOM Amendment (Multiple Common Bond Expansio NCUA_4015-EZ.pdf www.ncua.gov/Legal/GuidesEtc/CharteringAndFOMForms/NCUA_4015EZ.pdf	Form
NCUA 4015-EZ Application FOM Amendment (Multiple Common Bond Expansio NCUA_4015-EZ.pdf www.ncua.gov/Legal/GuidesEtc/CharteringAndFOMForms/NCUA_4015EZ.pdf	Form
NCUA 4015-A Application FOM Amendment (Multiple Common Bond Expansio NCUA_4015-A.pdf	Form
NCUA 4015-A Application FOM Amendment (Multiple Common Bond Expansio NCUA_4015-A.pdf	Form
NCUA 4000 Conversions of State Charter to Federal Charter (FCU Inv NCUA_4000.pdf www.ncua.gov/Legal/GuidesEtc/CharteringAndFOMForms/NCUA_4000.pdf	Form
NCUA 4000 Conversions of State Charter to Federal Charter (FCU Inv NCUA_4000.pdf www.ncua.gov/Legal/GuidesEtc/CharteringAndFOMForms/NCUA_4000.pdf	Form
NCUA 4221 Notice of Meeting of Members to Convert from a Federal t NCUA_4221.pdf www.ncua.gov/Legal/GuidesEtc/CharteringAndFOMForms/NCUA_4221.pdf	Form
NCUA 4221 Notice of Meeting of Members to Convert from a Federal t NCUA_4221.pdf www.ncua.gov/Legal/GuidesEtc/CharteringAndFOMForms/NCUA_4221.pdf	Form
NCUA 4401 Application to Convert From a State to a Federal CU NCUA_4401.pdf www.ncua.gov/Legal/GuidesEtc/CharteringAndFOMForms/NCUA_4401.pdf	Form
NCUA 4401 Application to Convert From a State to a Federal CU NCUA_4401.pdf www.ncua.gov/Legal/GuidesEtc/CharteringAndFOMForms/NCUA_4401.pdf	Form
NCUA 4505 Affidavit - Proof of Results Membership Vote NCUA_4505.pdf www.ncua.gov/Legal/GuidesEtc/CharteringAndFOMForms/NCUA_4505.pdf	Form
NCUA 4505 Affidavit - Proof of Results Membership Vote NCUA_4505.pdf www.ncua.gov/Legal/GuidesEtc/CharteringAndFOMForms/NCUA_4505.pdf	Form
NCUA 4506 Federal to State Conversion - Ballot for Conversion Prop NCUA_4506.pdf www.ncua.gov/Legal/GuidesEtc/CharteringAndFOMForms/NCUA_4506.pdf	Form
NCUA 4506 Federal to State Conversion - Ballot for Conversion Prop NCUA_4506.pdf www.ncua.gov/Legal/GuidesEtc/CharteringAndFOMForms/NCUA_4506.pdf	Form
4001 FCU Investigation Report NCUA_4001.pdf www.ncua.gov/Legal/GuidesEtc/CharteringAndFOMForms/NCUA_4001.pdf	Form and Instruction
4001 FCU Investigation Report NCUA_4001.pdf www.ncua.gov/Legal/GuidesEtc/CharteringAndFOMForms/NCUA_4001.pdf	Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Chartering and Field of Membership Manual

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

Obligation to Respond: Mandatory

CFR Citation: 12 CFR 701

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	NCUA 4008	Organization Certification	NCUA_4008.pdf	https://www.ncua.gov/Legal/GuidesEtc/CharteringAndFOMForms/NCUA_4008.pdf	Yes	No	Fillable Printable
Form	NCUA 4012	Report of Official and Agreement to Serve	NCUA_4012.pdf	https://www.ncua.gov/Legal/GuidesEtc/CharteringAndFOMForms/NCUA_4012.pdf	Yes	No	Fillable Printable
Form	NCUA 9500	Application and Agreements for Insurance of Accounts	NCUA_9500.pdf	https://www.ncua.gov/Legal/GuidesEtc/CharteringAndFOMForms/NCUA_9500.pdf	Yes	No	Fillable Printable
Form	NCUA 9501	Certification of Resolutions	NCUA_9501.pdf	https://www.ncua.gov/Legal/GuidesEtc/CharteringAndFOMForms/NCUA_9501.pdf	Yes	No	Fillable Printable
Form	NCUA 4015	Application FOM Amendment (Multiple Common Bond Expansion Groups of 3,000 or more)	NCUA_4015.pdf	https://www.ncua.gov/Legal/GuidesEtc/CharteringAndFOMForms/NCUA_4015.pdf	Yes	No	Fillable Printable
Form	NCUA 4015-EZ	Application FOM Amendment (Multiple Common Bond Expansions less than 3,000 and All Single Common Bond Expansions)	NCUA_4015-EZ.pdf	https://www.ncua.gov/Legal/GuidesEtc/CharteringAndFOMForms/NCUA_4015EZ.pdf	Yes	No	Fillable Printable
Form	NCUA 4015-A	Application FOM Amendment (Multiple Common Bond Expansion Groups of 3,000 to 4,999)	NCUA_4015-A.pdf		Yes	No	Fillable Printable
Form	NCUA 4000	Conversions of State Charter to Federal Charter (FCU Investigation Report)	NCUA_4000.pdf	https://www.ncua.gov/Legal/GuidesEtc/CharteringAndFOMForms/NCUA_4000.pdf	Yes	No	Fillable Printable
Form	NCUA 4221	Notice of Meeting of Members to Convert from a Federal to a State Chartered CU	NCUA_4221.pdf	https://www.ncua.gov/Legal/GuidesEtc/CharteringAndFOMForms/NCUA_4221.pdf	Yes	No	Fillable Printable
Form	NCUA 4401	Application to Convert From a State to a Federal CU	NCUA_4401.pdf	https://www.ncua.gov/Legal/GuidesEtc/CharteringAndFOMForms/NCUA_4401.pdf	Yes	No	Fillable Printable
Form	NCUA 4505	Affidavit - Proof of Results Membership Vote	NCUA_4505.pdf	https://www.ncua.gov/Legal/GuidesEtc/CharteringAndFOMForms/NCUA_4505.pdf	Yes	No	Fillable Printable
Form	NCUA 4506	Federal to State Conversion - Ballot for Conversion Proposal	NCUA_4506.pdf	https://www.ncua.gov/Legal/GuidesEtc/CharteringAndFOMForms/NCUA_4506.pdf	Yes	No	Fillable Printable
Form and Instruction	4001	FCU Investigation Report	NCUA_4001.pdf	https://www.ncua.gov/Legal/GuidesEtc/CharteringAndFOMForms/NCUA_4001.pdf	Yes	No	Fillable Printable

Federal Enterprise Architecture Business Reference Module

Line of Business: Economic Development

Subfunction: Business and Industry Development

Privacy Act System of Records

Title: Personnel Access and Security System (PASS)

FR Citation: 81 FR 12748

Number of Respondents: 8,245

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 90 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	8,245	90	8,155
Annual IC Time Burden (Hours)	16,223	40	16,183
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.