2011 Renewal_FHLB Directors Supporting Statement FINAL_for ROCIS

"FEDERAL HOME LOAN BANK DIRECTORS"
OMB NUMBER 2590-0006
SUPPORTING STATEMENT

A. JUSTIFICATION
1. Circumstances necessitating the collection of information
Section 7 of the Federal Home Loan Bank Act (Bank Act) vests the management of each Federal
Home Loan Bank (Bank) in its board of directors. See 12 U.S.C. 1427(a)(1). As required by
section 7, each Bank’s board comprises two types of directors: (1) member directors, who are
drawn from the officers and directors of member institutions located in the Bank’s district and
who are elected every four years to represent members in a particular state; and (2) independent
directors, who are unaffiliated with any Bank member and who are elected every four years on
an at-large basis in each Bank district. See 12 U.S.C. 1427(b) and (d). Section 7 and FHFA’s
implementing regulation, codified at 12 CFR part 1261, establish the eligibility requirements for
both types of Bank directors and the qualifications for independent directors, and set forth the
procedures for their election.
Under part 1261 of the regulations, the Banks determine the eligibility of nominees for member
and independent directorships and administer the annual director election process. As part of this
process, candidates for both types of directorship, including incumbents, are required to
complete and return to the Bank a form that solicits information about the candidate’s statutory
eligibility to serve and, in the case of independent director candidates, about his or her
qualifications for the directorship being sought. See 12 CFR 1261.7(c) and (f); 12 CFR
1261.14(b). Specifically, member director candidates are required to complete the Federal Home
Loan Bank Member Director Eligibility Certification Form (Member Director Eligibility
Certification Form), while independent director candidates must complete the Federal Home
Loan Bank Independent Director Application Form (Independent Director Application Form).
Part 1261 also requires that all directors certify annually that they continue to meet all eligibility
requirements. See 12 CFR 1261.12. Member directors do this by completing the Member
Director Eligibility Certification Form again every year, while Independent Directors complete
the abbreviated Federal Home Loan Bank Independent Director Annual Certification Form
(Independent Director Annual Certification Form) to certify their ongoing eligibility.
2. Use of Data
The Banks use the information collection contained in the Independent Director Application
Form and part 1261 to determine whether individuals who wish to stand for election or reelection as independent directors satisfy the statutory eligibility requirements and possess the
qualifications required under the statute and regulations. Only individuals meeting these
requirements and qualifications may serve as independent directors. See 12 U.S.C. § 1427(a)(3).

FEDERAL HOME LOAN BANK DIRECTORS: OMB NUMBER 2590-0006
SUPPORTING STATEMENT

On an annual basis after the election, the Banks use the information collection contained in the
Independent Director Annual Certification Form to determine whether independent directors
continue to meet these eligibility requirements and qualifications.
The Banks use the information collection in the Member Director Eligibility Certification Form
and part 1261 to determine whether individuals who wish to stand for election or re-election as
member directors satisfy the statutory eligibility requirements. Only individuals meeting these
requirements may serve as member directors. See 12 U.S.C. § 1427(a)(3) and (b)(1). On an
annual basis after the election, the Banks also use the information collection contained in the
Member Director Eligibility Certification Form to determine whether incumbent member
directors continue to meet the statutory eligibility requirements.
In practice, the Banks provide FHFA with copies of all completed Bank Director Forms, which
the agency uses to monitor the Bank director election processes and to obtain information on the
composition of the Banks’ boards of directors and of the pool of individuals from which the
directors are drawn. However, under the regulations, the Banks are required to submit only the
Independent Director Application Forms to FHFA. Once the forms are submitted, the Director of
FHFA has two weeks to provide the Banks with any desired commentary relating to an
independent director candidate. See 12 CFR 1261.7(f).
3. Use of Information Technology
Individuals have the option of completing each of the Bank Director Forms online in electronic
form, although there currently is no mechanism for providing an electronic signature or for
electronic submission of the form. Currently, forms that are completed online must be printed out
and submitted to the Bank in paper form with original signatures. FHFA is considering whether
it is practicable to provide a mechanism for electronic submission of the Bank Director Forms.
4. Efforts to Identify Duplication
The Banks are required by statute to collect the information requested on all three Bank Director
Forms and this information is not available from any other source.
5. Impact on Small Entities
The information collection does not have a significant economic impact on a substantial number
of small entities. The regulation implements statutory requirements and is applicable only to
individual respondents.
6. Consequences of Less Frequent Collection and Obstacles to Burden Reduction
If the information requested in the Bank Director Forms were not collected at the times specified
in part 1261, the Banks would be unable to determine, and FHFA would be unable to monitor,
whether prospective and incumbent directors satisfy the statutory eligibility requirements and (in
the case of independent directors and nominees) statutory and regulatory qualifications.

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FEDERAL HOME LOAN BANK DIRECTORS: OMB NUMBER 2590-0006
SUPPORTING STATEMENT

7. Circumstances Requiring Special Information Collection
There are no special circumstances that would require FHFA to conduct the information
collection in a manner inconsistent with the guidelines provided in Question 7.
8. Solicitation of Comments on Information Collection
In accordance with the requirements of 5 CFR § 1320.8(d), FHFA published a request for public
comments regarding this information collection in the Federal Register on May 25, 2011. See
76 FR 30344 (May 25, 2011). The 60-day comment period closed on July 25, 2011. FHFA
received one public comment which questioned whether the instructions to questions 4-6 on the
Member Director Eligibility Certification Form were phrased so as to accurately reflect one of
the statutory requirements pertaining to the eligibility of an individual to serve as a member
director of a Bank. In response to this comment, FHFA has revised question 6 of that form and
its related instruction so that they more accurately state the statutory standard. These revisions
have not resulted in any changes to the cost and burden estimates. The agency determined that
the instructions to questions 4-5 do not need to be revised. FHFA received no comments
addressing the cost and hour burden estimates.
9. Provision of Payments to Respondents
No payment or gift will be provided to any respondent.
10. Assurance of Confidentiality
FHFA and the Banks maintain the confidentiality of information obtained from respondents as
required by applicable statute, regulation or agency policy.
11. Justification of Sensitive Questions
There are no questions of a sensitive nature in the information collection.
12. Estimated Burden of Information Collection
FHFA has analyzed the cost and hour burden to determine the eligibility of member and
independent directors and director nominees. The aggregate total annual cost and hour burden for
the information collection is as follows:

Cost:
Hours:

FHFA

Prospective/
Incumbents

TOTAL

$6,862
73

$68,944
278

$75,806
351

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FEDERAL HOME LOAN BANK DIRECTORS: OMB NUMBER 2590-0006
SUPPORTING STATEMENT

The method FHFA used to determine the annual cost and hour burden is explained in detail
below.
I.

Member Director Form

FHFA based the calculations upon an annual average of 100 prospective member directors and
80 incumbent member directors. The aggregate total annual cost and hour burden is as follows:

Cost:
Hours:
A.

FHFA

Prospective/
Incumbents

TOTAL

$0
0

$17,360
70

$17,360
70

FHFA Annualized Burden

FHFA incurs no costs because it does not formally review the Member Director Eligibility
Certification Forms.
B.

Incumbent and Prospective Member Directors’ Annualized Burden

The estimated annualized cost for all prospective and incumbent member directors is $17,360.
The estimated annualized hour burden is 70 hours. These estimates are based on the following
calculations:
Member director nominee reviews the nomination notice and completes and submits the Member
Director Eligibility Certification Form to the Bank.






Review/processing time: .5 hours
Total notices/Forms: 100
Total hours: 50
Hourly rate: $248 (includes salary, benefits, and overhead)
Total cost: $12,400

Each incumbent member director completes and submits to the Bank an annual update to the
Member Director Eligibility Certification Form.






II.

Processing time: .25 hours
Total Forms: 80
Total hours: 20
Hourly rate: $248 (includes salary, benefits and overhead)
Total cost: $4,960
Independent Directors

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FEDERAL HOME LOAN BANK DIRECTORS: OMB NUMBER 2590-0006
SUPPORTING STATEMENT

FHFA based the calculations upon an annual average of 60 prospective independent directors, 30
of which eventually become candidates for election, and 55 incumbent independent directors.
The aggregate total annual cost and hour burden is as follows:

Cost:
Hours:
A.

FHFA

Prospective/
Incumbents

TOTAL

$6,862
73

$51,584
208

$58,446
281

FHFA’s Annualized Burden

The estimated annualized cost to FHFA to review the Independent Director Application Form
and the Independent Director Annual Certification Form is $6,862. The estimated annualized
hour burden is 73 hours. These estimates are based on the following calculations:
Staff reviews each Independent Director Application Form to ensure compliance with the
statutory eligibility and statutory/regulatory qualification requirements.






Review/Processing time: 1.5 hours
Total Forms: 30
Total hours: 45
Hourly rate: $94 (includes salary, benefits, and overhead)
Total cost: $4,230

Staff reviews each Independent Director Annual Certification Form submitted by an incumbent
independent director to ensure compliance with statutory eligibility and statutory/regulatory
reporting requirements.






B.

Review time: .5 hours
Total Forms: 55
Total hours: 28
Hourly rate: $94 (includes salary, benefits, and overhead)
Total cost: $2,632
Incumbent and Prospective Directors’ Annualized Burden

The estimated annualized cost for all prospective and incumbent independent directors is
$51,584. The estimated annualized hour burden is 208 hours. These estimates are based on the
following calculations:
Independent director candidate completes the Independent Director Application Form and
submits it to the Bank.


Processing time: 3 hours

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FEDERAL HOME LOAN BANK DIRECTORS: OMB NUMBER 2590-0006
SUPPORTING STATEMENT






Total Forms: 60
Total hours: 180
Hourly rate: $248 (includes salary, benefits, and overhead)
Total cost: $44,640

Each incumbent independent director completes and submits the Independent Director Annual
Certification Form to the Bank.






Processing time: .5 hours
Total Forms: 55
Total hours: 28
Hourly rate: $248 (includes salary, benefits, and overhead)
Total cost: $6,944

13. Estimated Total Annual Cost Burden to Respondents
There are no additional startup costs for incumbent or prospective directors. The estimated
annual cost to incumbent and prospective directors is $68,944. The method used to determine
these costs is discussed in detail under Question 12.
14. Estimated Cost to the Federal Government
The estimated annual cost burden to the Federal government is $6,862. The method used to
determine these costs is discussed in detail under Question 12.
15. Reasons for Change in Burden
The hourly and estimated annual cost burdens have not changed since the approval of the
Emergency Request six-months ago by OMB in January 2011.
16. Plans for Tabulation, Statistical Analysis and Publication
FHFA will not publish the results of this information collection.
17. If Seeking Approval to Not Display the Expiration Date for OMB Approval of the
Information Collection, Explain the Reasons Whey Display Would Be Inappropriate
FHFA plans to display the expiration date for OMB approval.
18. Explain Each Exception to the Topics of the Certification Statement Identified in
“Certification for Paperwork Reduction Act Submission.”
There are no exceptions to the certification statement identified in Item 19.

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FEDERAL HOME LOAN BANK DIRECTORS: OMB NUMBER 2590-0006
SUPPORTING STATEMENT

B. COLLECTION OF INFORMATION EMPLOYING STATISTICAL METHODS
The information collection does not employ statistical methods.
Attachments (Forms)

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FEDERAL HOME LOAN BANK
MEMBER DIRECTOR
ELIGIBILITY CERTIFICATION FORM
1. Print or type your full name:
________________________________________________________________________
2. Are you a citizen of the United States? Yes

No

3. Provide the address of your principal residence:
________________________
Street

_____________________
City

__________
State

_________
Zip code

4. Provide the following information about the institution you serve as an officer or director that
is a member of your Federal Home Loan Bank:
__________________________________
Name of member
________________
Telephone number
________________________
Street

_________________________________
Your title or position

__________________
Fax number

_______________________
E-mail address

____________________
City

__________
State

_________
Zip code

________________________ ____________________
Mailing address (if different) City

__________
State

_________
Zip code

5. Provide the name and location of any other institution you serve as an officer or a director
that is a member of any Federal Home Loan Bank:
______________________
Name of member

________________
City

_________
State

__________________
Your title or position

______________________
Name of member

________________
City

_________
State

__________________
Your title or position

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Page 1 of 4

FEDERAL HOME LOAN BANK MEMBER DIRECTOR ELIGIBILITY CERTIFICATION FORM

6. Does each member listed in LINE 4 and LINE 5 comply with all of its applicable minimum
capital requirements established by its appropriate federal or state regulator?
Yes

No

If you answered No, identify the non-compliant institution and note the Bank of which it is a
member.
__________________________________________
Name of member

___________________________
Bank District

__________________________________________
Name of member

___________________________
Bank District

I HEREBY CERTIFY that the information provided on this Federal Home Loan Bank Member
Director Eligibility Certification Form is true, correct, and complete to the best of my
knowledge.

____________________________________
Signature

_________________________
Date

State of ________________)
County of ______________)
Signed and sworn to before me this ____ day of __________________ of 20___.
_________________________________
Signature of Notary Public
(Notarial Seal)

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My commission expires: _____________________

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DIRECTIONS
If you need assistance in completing this Form or have any questions, please contact:
Name:
Federal Home Loan Bank of
Address:
Telephone:
Fax:
E-Mail:
Who Must File and When
The Federal Home Loan Bank (Bank) uses the information you provide on this Form to
determine whether you meet the statutory and regulatory eligibility requirements to serve as a
member director. You can find these requirements in section 1427 of Title 12 of the United
States Code (12 U.S.C. § 1427) and in part 1261 of Title 12 of the Code of Federal Regulations
(12 C.F.R. part 1261). A copy of the statutory and regulatory eligibility requirements is enclosed
for your reference. Only individuals who satisfy these requirements may run for a member
directorship or serve as a member director.
Nominees for a Member Bank Directorship
If you wish to accept a nomination to serve as a member director, you must complete this Form
and return it to the Bank on or before ___________________. If you do not submit this Form to
the Bank by the deadline, you will be deemed to have declined the nomination.
Incumbent Member Bank Directors
Every year, each incumbent member director must complete this Form and return it to the Bank
on or before March 1st. The Bank will use the information to confirm your continued eligibility
to serve as a member director. If you do not submit this form by the March 1st deadline, the
Bank may declare that you are no longer eligible to serve as a member director, and may declare
vacant the member directorship that you hold. If March 1st falls on a Saturday, Sunday, or
federal holiday, you have until the next business day to submit the completed Form.
Individuals Selected to Fill a Vacancy
If the Bank selected you to fill a vacancy on the board of directors, you must complete this Form
and return it to the Bank on or before _______________. You cannot become a member
director unless you complete and return the Form to the Bank.

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FEDERAL HOME LOAN BANK MEMBER DIRECTOR ELIGIBILITY CERTIFICATION FORM: DIRECTIONS

Line-by-Line Instructions
LINE 1. Print or type your full name.
LINE 2. You must be a United States citizen in order to serve as a member director. Check the
appropriate answer.
LINE 3. Provide the address of your principal residence.
LINE 4. You must be an officer or a director of an institution that is a member of the Bank in
order to be a member director of that Bank. In addition, the member must be located in the state
within the Bank district that is to be represented by the directorship you wish to hold. In most
cases, a member will be deemed to be located where it maintains its home office or its principal
place of business. Provide the requested information for the member you serve as an officer or
director, as well as your title or position at that institution.
LINE 5. If you are an officer or director of any other institution that is a member of this or any
other Bank, provide the name and location of the institution(s), as well as the position that you
hold at the institution(s).
LINE 6. In order for you to be eligible to serve as a member director, every institution that
you serve as an officer or director that is a member of the Bank in which you wish to hold a
directorship must be in compliance with all of its applicable minimum capital requirements
established by its appropriate federal or state regulator. The term “appropriate federal
regulator” has the same meaning as the term “appropriate Federal banking agency” in
section 3(q) of the Federal Deposit Insurance Act (12 U.S.C. § 1813(q)) and, for federally
insured credit unions, means the National Credit Union Administration. The term
“appropriate state regulator” means any state officer, agency, supervisor, or other entity that
has regulatory authority over, or is empowered to institute enforcement action against, a
member.

Check the appropriate answer as to whether each institution you listed in LINE 4 and
LINE 5 is in compliance with all of the applicable minimum capital requirements
established by its appropriate federal or state regulator. If the answer is No, you must list
each non-compliant institution regardless of the Bank of which it is a member. However,
your status as an officer or director of a non-compliant institution will render you ineligible
to serve as a Bank director only if that institution is a member of the Bank in which you
wish to hold a directorship.
Privacy Act Statement: In accordance with the Privacy Act (5 U.S.C. 552a), the following notice is provided. This information is solicited
under authority of 12 U.S.C. 1427(a) and (b); and 12 CFR 1261.5, 1261.7, and 1261.10 to 1261.13. Furnishing the information on this form
is voluntary, but failure to do so may result in you not meeting the statutory and regulatory eligibility requirements to serve as a member
director. The purpose of this information is to facilitate the timely determination of your eligibility to serve as a member director. Information
may be disclosed in accordance with the routine uses identified in FHFA-System of Records Notice FHFA-8 Federal Home Loan Bank
Directors, which may be found at http://www.fhfa.gov/webfiles/21534/Notice%20FHFA%20SORs%20(FHFA-7%20to%20FHFA13)_published%2076%20FR%2033286%20(6-8-11)%20(2).pdf).
Paperwork Reduction Act Statement: Notwithstanding any other provision of the law, no person is required to respond to, nor shall any
person be subject to a penalty for failure to comply with, a collection of information subject to the requirements of the Paperwork Reduction
Act, unless that collection of information displays a currently valid OMB Control Number.

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FEDERAL HOME LOAN BANK
INDEPENDENT DIRECTOR
APPLICATION FORM

PERSONAL INFORMATION
Full name: _____________________________________________________________
Address:

Current employment:
_______________________________________
Name of organization
____________________
Telephone number

________________________________
Your title or position

____________________
Fax number

__________________________
E-mail address

_____________________________
Street

__________________
City

_______
State

_________
Zip code

_____________________________
Mailing address (if different)

_________________
City

________
State

_________
Zip code

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STATUTORY ELIGIBLITY REQUIREMENTS
An individual must satisfy certain statutory requirements in order to be eligible for election as an
independent director of a Federal Home Loan Bank (Bank). The requirements relate to
citizenship, residency, and, for prospective public interest directors, experience in that field. The
statute also prohibits an independent director from serving as an officer, employee, or director of
an institution that is a member of, or that receives advances from, the Bank on whose board the
director serves. The questions below address these statutory requirements.
1. Citizenship. Are you a citizen of the United States? Yes

No

2. Residency. In order to be an independent director you must be a bona fide resident of a state
that is in the geographic district of the Bank on whose board you wish to serve. You will satisfy
this requirement if your principal residence is located in that geographic district (A), or if you
own or lease a second residence in the district and are employed in the district (B). Please
indicate the basis you are using to demonstrate bona fide residence.
A. Is your principal residence located in the Bank’s geographic district? Yes

No

B. If you answered No, do you own or lease a second residence in the Bank’s district and are
you employed in the district? Yes
No
If so, provide the address of your second home, the name of, and identifying information on,
your employer, and your title or position, if different from that on page 1 of this Form.
Second home address:

Employer information:
______________________________________
Name of organization
_____________________
Telephone number

__________________________________
Your title or position

_________________
Fax number

__________________________
E-mail address

_____________________________
Street

________________
City

______________
State

________
Zip code

_____________________________
Mailing address (if different)

_____________
City

____________
State

________
Zip code

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3. Public Interest Directors. If you are seeking election as a public interest director, you must
be able to demonstrate that you have more than four years experience representing consumer or
community interests on banking services, credit needs, housing, or consumer financial
protections.
If you meet this requirement, provide information on how you have represented such consumer
or community interests for more than four years.

4. Conflicts of interest. Independent directors and their spouses may not serve as an officer of
any Bank or as an officer, employee, or director of any member of, or any recipient of advances
from, the Bank on whose board the independent director serves. You and your spouse will have
to give up any conflicting position before you can become a Bank director.
For purposes of this conflict of interest provision, the terms:
“Member” and “Recipient of advances” include the institution itself and any subsidiary of the
institution. If the institution is owned by a holding company, the terms include the holding
company if 35 percent or more of the holding company’s assets, on a consolidated basis, are
attributable to institutions that are members of, or recipients of advances from, the Bank on
whose board the independent director serves. Thus, you may not serve as a director, employee,
or officer of a holding company if one or more members of, or one or more recipients of
advances from, your Bank constitute 35 percent or more of the holding company’s assets.
A. Please specify each position you and your spouse have in any member of, or recipient of
advances from, the Bank on whose board you would serve.

B. Do you agree to give up positions that are deemed to be conflicting interests before
becoming an independent director of that Bank? Yes
No

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SELECTION CRITERIA
The Banks are multi-billion dollar financial institutions, the principal business of which is to
borrow funds in the capital markets and then provide secured loans to their members. Each Bank
is required to have independent directors who possess knowledge or expertise in financial
management, derivatives, auditing and accounting, risk management practices, project
development, organizational management, or the law.
1. Leadership Experience. Bank directors should have experience in senior management or
policy-making in one or more fields of business, government, education, or community/civic
affairs, and should have a record of achievement in their chosen profession or field of business.
This experience should provide directors with the ability to understand the business of the Bank,
to act independently, and to ask Bank management appropriate questions about how they are
conducting Bank business.
A. If you have ever served as the CEO, CFO, COO, or in a similar capacity for a business
enterprise, or as a dean or senior faculty member at a prominent college or university, or as a
senior official for a federal or state government or prominent nonprofit organization, please
provide the details for those positions, including the dates of service and the positions held.

B. If you have other experience dealing with issues such as developing or implementing
business strategies, overseeing regulatory compliance, corporate governance, or board
operations, or have previously served on the board of a large business enterprise, please
describe those experiences.

C. If you have other significant business or professional achievements that demonstrate your
ability to lead an organization please describe them.

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2. Business Knowledge. Bank directors must be financially literate, meaning they must be
familiar with how financial statements and various financial ratios are used in managing a
business enterprise, how basic accounting conventions apply to the Bank, and how internal
controls are used to manage risk. They also must have some knowledge about one or more of the
areas of the Bank’s business, such as mortgage finance, capital markets transactions,
accounting/modeling practices, affordable housing, community and economic development, and
legal and regulatory compliance.
A. Do you know how to read and understand a financial statement, and do you understand
how financial ratios and other indices are used for evaluating the performance of a business
enterprise? Yes
No
If you answered Yes, please describe the setting in which you gained that knowledge.

B. Do you have a working familiarity with basic finance and accounting practices, including
internal controls and risk management? Yes
No
If you answered Yes, please describe the setting in which you acquired that knowledge.

C. Do you have experience with financial accounting and auditing, particularly with a
publicly traded company? Yes
No
If you answered Yes, please describe that experience.

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D. Do you have experience in project development or organizational management?
Yes
No
If you answered Yes, please describe that experience.

E. Do you have experience in an organization providing financing for residential mortgages,
housing for low or moderate income individuals and families, or real estate development?
Yes
No
If you answered Yes, please describe that experience.

F. Have you served in any position that required an understanding of the legal and other
fiduciary obligations associated with being an independent director? Yes
No
If you answered Yes, please describe that experience.

G. The mission of the Banks is to support the housing finance activities of their members,
which includes residential mortgage finance and community and economic development
lending activities. Please describe any prior experience that is related to the mission of the
Banks.

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3. Commitment to Service. In order to serve effectively on the board of a Bank, a director must
be able to attend the meetings of the board of directors and subcommittees on which the director
serves, and to devote the time necessary to prepare for those meetings.
A. Do you have any other business or professional commitments that would hinder your
ability to prepare for and attend board of director and committee meetings? Yes
No
If so, please describe the constraints on your ability to serve.

B. If you serve on any other corporate boards, please provide the name and location of the
organization, your role (e.g., chair and committee assignments), and the term of service.
___________________________
Name of organization

_______________________
Your role

________________
Term

___________________________
Name of organization

_______________________
Your role

________________
Term

___________________________
Name of organization

_______________________
Your role

________________
Term

4. Personal Integrity. Character is an important consideration in evaluating any prospective
Bank director. All directors must have high ethical standards and integrity in both their personal
and professional dealings. Please indicate whether you ever have been convicted of a felony,
been found to have violated any federal or state civil laws relating to the securities, banking,
housing or real estate industries, or have had a professional license suspended or revoked.
Yes
No
If you answered Yes, please explain.

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5. Independence. It is essential that an independent director be able to act independently of
management in overseeing the policy and operations of a Bank, and not have any relationships
that may create actual or apparent conflicts of interest. Please disclose whether you have any
familial or business relationships with any members of Bank management or the board of
directors of the Bank, and any other relationship(s) that might lead a reasonable person to
question your independence. Yes
No
If you answered Yes, please explain.

6. Other Experience and Education. Please provide a copy of your resume if it describes other
business, professional, or educational achievements that are not described in the responses to the
questions above. Resume attached. Yes
No
BY EXECUTING AND SUBMITTING THIS APPLICATION FORM, YOU ARE
CERTIFYING THAT THE INFORMATION YOU PROVIDED IS TRUE, CORRECT,
AND COMPLETE TO THE BEST OF YOUR KNOWLEDGE AND THAT YOU AGREE
TO SERVE AS A DIRECTOR IF ELECTED.

________________________________________
Signature

_______________________
Date

Privacy Act Statement: In accordance with the Privacy Act (5 U.S.C. 552a), the following notice is provided. This information is solicited
under authority of 12 U.S.C. 1427(a) and (b); and 12 CFR 1261.5, 1261.7, and 1261.10 to 1261.13. Furnishing the information on this form
is voluntary, but failure to do so may result in you not meeting the statutory and regulatory eligibility requirements to serve as an independent
director. The purpose of this information is to facilitate the timely determination of your eligibility to serve as an independent director.
Information may be disclosed in accordance with the routine uses identified in FHFA-System of Records Notice FHFA-8 Federal Home Loan
Bank Directors, which may be found at http://www.fhfa.gov/webfiles/21534/Notice%20FHFA%20SORs%20(FHFA-7%20to%20FHFA13)_published%2076%20FR%2033286%20(6-8-11)%20(2).pdf).
Paperwork Reduction Act Statement: Notwithstanding any other provision of the law, no person is required to respond to, nor shall any
person be subject to a penalty for failure to comply with, a collection of information subject to the requirements of the Paperwork Reduction
Act, unless that collection of information displays a currently valid OMB Control Number.

Expires 8/31/2011
OMB No. 2590-0006

Page 8 of 8

FEDERAL HOME LOAN BANK
INDEPENDENT DIRECTOR
ANNUAL CERTIFICATION FORM
Full name: _____________________________________________________________
Federal Home Loan Bank of: ______________________________________________
Every year, each incumbent independent Federal Home Loan Bank (Bank) director must certify that
he or she continues to meet all of the following requirements:



United States citizen
Bona fide resident of a state in the geographic district of the Bank on whose board you serve
o your principal residence is located in that geographic district OR
o you own or lease a second residence in the district and are employed in the district



During your term of office, you and your spouse may not:
o serve as an officer of any Federal Home Loan Bank
o serve as an officer, employee, or director of any member or subsidiary of a member of the
Bank you serve, or any holding company that controls one or more members of the Bank
you serve if the assets of all such members constitute 35 percent or more of the assets of the
holding company, on a consolidated basis
o serve as an officer, employee, or director of any recipient of advances from the Bank you
serve, or any holding company that controls one or more recipients of advances from the
Bank you serve if the assets of all such recipients constitute 35 percent or more of the assets
of the holding company, on a consolidated basis



To be designated a public interest director, you must have more than four years experience
representing consumer or community interests on banking services, credit needs, housing, or
consumer financial protections
If you are not designated as a public interest director, you must have knowledge or experience in
one of the following: auditing and accounting, derivatives, financial management, organizational
management, project development, risk management practices, or the law.



By executing this form, you are certifying that you continue to meet these
requirements and that the director application form you submitted previously, or
any amended certification form you submitted previously, is true, correct, and
complete to the best of your knowledge.

Expires 8/31/2011
OMB No. 2590-0006

Page 1 of 2

Please check one box:
No changes have occurred.
Changes have occurred to my responses in these sections of my Form:
Personal information:

Eligibility information, including conflicts of interest:

Commitment to serve:

Personal integrity:

Independence:

Other changes:

Dated: ___________________________________
Signature: ________________________________________________

Privacy Act Statement: In accordance with the Privacy Act (5 U.S.C. 552a), the following notice is provided. This information is solicited
under authority of 12 U.S.C. 1427(a) and (b); and 12 CFR 1261.5, 1261.7, and 1261.10 to 1261.13. Furnishing the information on this form is
voluntary, but failure to do so may result in you not meeting the statutory and regulatory eligibility requirements to serve as an independent
director. The purpose of this information is to facilitate the timely determination of your eligibility to serve as an independent director.
Information may be disclosed in accordance with the routine uses identified in FHFA-System of Records Notice FHFA-8 Federal Home Loan
Bank Directors, which may be found at http://www.fhfa.gov/webfiles/21534/Notice%20FHFA%20SORs%20(FHFA-7%20to%20FHFA13)_published%2076%20FR%2033286%20(6-8-11)%20(2).pdf).
Paperwork Reduction Act Statement: Notwithstanding any other provision of the law, no person is required to respond to, nor shall any
person be subject to a penalty for failure to comply with, a collection of information subject to the requirements of the Paperwork Reduction Act,
unless that collection of information displays a currently valid OMB Control Number.

Expires 8/31/2011
OMB No. 2590-0006

Page 2 of 2