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pdfMLR RSF
Identifying Information
Charter Number
Bank Name
00000
Test Bank
Cash Intensive Businesses
Please refer to the User Guide for instructions on how to fill out the form. Depending on the PSC, different rules may apply.
Do you have anything to report?
Total Number
Total Volume
1. Convenience Stores
0
0
2. Liquor Stores
0
0
3. Independent ATM Owners/Operators
0
0
4. Domestic Charitable Organizations
0
0
0
0
0
0
0
0
5. Jewelry, Gem & Precious Metal Dealers
6. Casinos
7. Car Dealers
Page 1 of 13
MLR RSF
Domestic Accounts
Please refer to the User Guide for instructions on how to fill out the form. Depending on the PSC, different rules may apply.
Do you have anything to report?
Total Number
Total Volume
8. Domestic Private Banking
0
0
9. Domestic Commercial Letters of Credit
0
0
10. Stand-by Letters of Credit
0
0
Page 2 of 13
MLR RSF
Domestic Customers
Please refer to the User Guide for instructions on how to fill out the form. Depending on the PSC, different rules may apply.
Do you have anything to report?
Total Number
Total Volume
11. Marijuana Related Businesses
0
0
12. Customers/Accounts opened through
the Internet, Mail, Wire or Phone (nonbranch)
0
0
13. Domestic Deposit Brokers
0
0
14. Travel Agencies
0
0
15. Broker Dealers
0
0
16. Telemarketers
0
0
17. Remotely Created Check Customers
0
0
18. Domestic Remote Deposit Capture
Customers
0
0
19. Third Party Senders
0
0
Page 3 of 13
MLR RSF
Domestic Transactions
Please refer to the User Guide for instructions on how to fill out the form. Depending on the PSC, different rules may apply.
Do you have anything to report?
Total Number
Total Volume
20. Cash Transactions
0
0
21. Issuance of Traveler's Checks,
Official Bank Checks & Money Orders
0
0
22. Domestic Wire Transfers
0
0
23. Domestic PUPIDs Wire Transfers
0
0
24. ACH
0
0
25. Remotely Created Checks
0
0
26. Domestic Remote Deposit Capture
0
0
Page 4 of 13
MLR RSF
Foreign Customers
Please refer to the User Guide for instructions on how to fill out the form. Depending on the PSC, different rules may apply.
Do you have anything to report?
Total Number
Total Volume
27. Non-Resident Alien Accounts
Non-Resident Alien Accounts Total
0
0
0
0
0
0
0
0
Charitable Orgs. (Foreign) Total
0
0
32. Import/Export
0
0
28. Politically Exposed Persons
Politically Exposed Persons Total
29. Foreign Off-Shore Corporations
Foreign Off-Shore Corporations Total
30. Foreign Deposit Brokers
Foreign Deposit Brokers Total
31. Foreign Charitable Organizations
33. Foreign Remote Deposit Capture Customers
Foreign Remote Deposit Capture
Customers Total
0
0
Page 5 of 13
MLR RSF
International Accounts
Please refer to the User Guide for instructions on how to fill out the form. Depending on the PSC, different rules may apply.
Do you have anything to report?
Total Number
Total Volume
34. Foreign Correspondent Accounts
Foreign Correspondent Accounts Total
0
0
0
0
0
0
35. Payable Through Accounts
Payable Through Accounts Total
36. Pouch Services
Pouch Services Total
37. Foreign Bank Affiliate (e.g. Parallel Banks)
Foreign Bank Affiliate (e.g. Parallel
Banks) Total
0
0
0
0
0
0
0
0
38. International Department
International Department Total
39. International Private Banking
International Private Banking Total
40. Embassy & Consulate Banking
Embassy & Consulate Banking Total
41. International Commercial Letters of Credit
International Commercial Letters of
Credit Total
0
0
Page 6 of 13
MLR RSF
International Transactions
Please refer to the User Guide for instructions on how to fill out the form. Depending on the PSC, different rules may apply.
Do you have anything to report?
Total Number
Total Volume
42. International Bank Drafts
International Bank Drafts Total
0
0
0
0
0
0
0
0
0
0
0
0
43. International Wire Transfers
International Wire Transfers Total
44. International PUPID Wire Transfers
International PUPID Wire Transfers Total
45. Remittance Products
Remittance Products Total
46. Cross-Border ACH
Cross-Border ACH Total
47. International Remote Deposit Capture
International Remote Deposit Capture
Total
Page 7 of 13
MLR RSF
Money Services Businesses
Please refer to the User Guide for instructions on how to fill out the form. Depending on the PSC, different rules may apply.
Do you have anything to report?
Total Number
48. Domestic Casas de Cambio/
Currency Exchange
Total Volume
0
0
Foreign Casas de Cambio/Currency
Exchange Total
0
0
50. Money Transmitters
0
0
51. Check Cashers
0
0
52. Issuers or Sellers of Traveler's
Checks or Money Orders
0
0
53. Providers of Prepaid Access
0
0
54. Sellers of Prepaid Access
0
0
49. Foreign Casas de Cambio/Currency
Exchange
Page 8 of 13
MLR RSF
Prepaid Cards
Please refer to the User Guide for instructions on how to fill out the form. Depending on the PSC, different rules may apply.
Do you have anything to report?
Total Number
Total Volume
55. Prepaid Cards
Geographical Focus: Enter information for all applicable geographies.
Prepaid Cards - Reloadable
0
0
Prepaid Cards - Non-Reloadable
0
0
Prepaid Cards Total
0
0
56. Prepaid Card Programs - Third Party Sponsored
Geographical Focus: Enter information for all applicable geographies.
Prepaid Card Programs Third Party Sponsored Reloadable
0
0
Prepaid Card Programs Third Party Sponsored Non-Reloadable
0
0
Prepaid Card Programs - Third Party
Sponsored Total
0
0
57. Prepaid Card Programs - Bank Sponsored
Geographical Focus: Enter information for all applicable geographies.
Prepaid Card Programs - Bank Sponsored Reloadable
0
0
Prepaid Card Programs - Bank Sponsored - NonReloadable
0
0
Prepaid Card Programs - Bank Sponsored
Total
0
0
58. Prepaid Cardholders
Geographical Focus: Enter information for all applicable geographies.
Prepaid Cardholders - Reloadable
0
0
Prepaid Cardholders - Non-Reloadable
0
0
Prepaid Cardholders Total
0
0
Page 9 of 13
MLR RSF
59. Prepaid Card Program Managers
Prepaid Card Program Managers Total
0
0
Page 10 of 13
MLR RSF
Trust Department / Investments / Brokered Accounts
Please refer to the User Guide for instructions on how to fill out the form. Depending on the PSC, different rules may apply.
Do you have anything to report?
Total Number
60. Domestic Charitable Trusts &
Foundations
0
Total Volume
0
61. Foreign Charitable Trusts & Foundations
Foreign Charitable Trusts & Foundations
Total
0
0
62. Custodial Accounts
0
0
63. Investment Advisory Accounts
0
0
64. Revocable Trusts
0
0
65. Foreign Grantor or Beneficiaries
0
0
66. Loans to Closely Held Corporations
0
0
67. Brokerage Department/Operations
0
0
68. Investment Advisory/Management
0
0
Page 11 of 13
MLR RSF
Crypto Assets
Please refer to the User Guide for instructions on how to fill out the form. Depending on the PSC, different rules may apply.
Do you have anything to report?
Total Number
Total Volume
69. Crypto-Assets Custody
0
0
70. Stablecoin Reserve
0
0
71. Stablecoin Payments/Issuance
0
0
Page 12 of 13
MLR RSF
Optional Feedback
Optional: Feedback/Suggestions on ways to improve the Risk Summary Form and OCC's Money Laundering Risk System data
collection process. In Addition, you may include pertinent information regarding your submitted data
Paperwork Reducation Act Statement:
This collection of information has been approved by the Office of Management and Budget (OMB) under control number xxxx-xxxx.
Under the paperwork Reduction Act, an agency may not conduct or sponsor, and a person is not required to respond to, a
collection of information unless it displays a currently a valid OMB control Number. The OCC estimates that it will take community
bank, federal branches and agency respondents 8 hours to complete this form.
Page 13 of 13
| File Type | application/pdf |
| File Title | D:\Adobe\Adobe_Experience_Manager_Forms\crx-repository\temp\pdfg-sv.livecycleadmin\b8\ad9e-3e2e3d-9da67e-481593-24233a-f15ac3\un |
| File Modified | 2022-08-22 |
| File Created | 2022-08-22 |