Form FDIC 6900-01 FDIC 6900-01 Youth Savings Pilot (YSP)

PAPERWORK REDUCTION ACT NOTICE

The information collected on this form will be used in the development of a report that identifies promising approaches for banks combining financial education with access to a savings account.  Public reporting burden for this collection of information is estimated to average 1 ½  hour per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.  Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Paperwork Reduction Act Clearance Officer, Legal Division, Federal Deposit Insurance Corporation, 550 17^th Street, N.W., Washington, D.C. 20429, and the Office of Management and Budget, Paperwork Reduction Project (3064-0143), Washington, D.C. 20503.   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 valid OMB control number.

Page down to access form FDIC 6900/01

OMB Number: 3064-0127

Expiration Date: 03-31-2017

Federal Deposit Insurance Corporation YOUTH SAVINGS PILOT PROGRAM PARTICIPANT REPORTING FORM
INSTRUCTIONS: Please complete the form in its entirety.
SECTION I – BANK FEEDBACK
1. Contact Name					2. Contact Number (Include Area Code)
     					     
3. Contact Email Address
     
4. Bank Name				5. Certificate Number
     				     
6. Report Date		7. Reporting Phase (Check one only)
     		Phase I Phase II
ACCOUNTS OF PARTICIPATING YOUTH
8. Prior to this period, how many youth savings accounts did you have?      			a. How many youth savings accounts were added this period?      
9. How many youth savings accounts were closed this period?      			a. How many current youth savings accounts do you have?      
10. What was the average account balance at the end of this period?      
11. What are the key contributions made by your partners (e.g., participating schools and non-profit organizations)?
     
12. What financial education materials or resources are used?
     
13. How do you measure or define your program’s success?
     
14. Provide an estimate of the annual program costs $     _____.
a. Provide an estimate of the annual number of participants     _________.
b. Provide an estimate of the cost per participant $    _____________.
15. What costs are included in your program and what is the largest cost (e.g., salaries, development and distribution of materials, promotional items etc.)?
     
16. What non-bank resources are used to carry out the program (e.g., school facilities, administrators, teachers, parents, volunteers, etc.)?
     
17. Do you believe the program resulted in new account relationships with others besides participating youth (e.g., parents or employees of the partnering organizations)? Yes No (Explain below.)
     
18. Will you continue the Youth Savings Program over the next few years? Yes No (Explain below.)
     
19. May we contact your partners to learn their experiences? Yes No (If “Yes,” provide the school’s or non-profit organization’s contact name, telephone number, and email address.)
Name	Telephone Number (Include Area Code)				Email Address
     	     				     

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SECTION II – SCHOOL (OR NON-PROFIT ORGANIZATION) FEEDBACK
20. Contact Name		21. Contact Number (Include Area Code)
     		     
22. Contact Email Address
     
23. School (or non-profit organization) Name		24. Grade(s) of participating students
     		     
25. Report Date (mm/dd/yyyy)	26. Is this a Title I School?	27. School Year? (Check one only)
     	Yes No	2014-2015 2015-2016
28. What financial education topics and curricula are taught to your students? Who delivers the programs (i.e., teachers, bankers, others)?      
29. Are there ways in which the financial education curriculum or experiential learning can be better tailored to meet the school’s goals? Yes No (Explain below.)      
30. In what ways have your students’ financial knowledge been affected by the financial education they have received?      
31. In what ways have your students’ financial behavior been affected by the financial education they have received?      
32. In what ways have your students’ understanding of finances been impacted by the financial education they have received?      
33. Did you engage with parents on financial management topics? If so, how and what were the results?      
34. Has this program had any influence on your students’ academic performance? Yes No (Explain below.)      

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