Application for Conversion; Proxy Statement; Offering Circular; Order Form

Forms and Documents

Document Name	Status
Form Form 1683 Order Form Form and Instruction	New
Form Form 1682 Offering Circular Form and Instruction	New
Form Form 1681 Proxy Statement Form and Instruction	New
Form Form 1680 Application for Conversion Form and Instruction	Modified
Form1680_Form1681_Form1682_Form1683_20160126_omb.pdf Supporting Statement A	2016-01-27

IC Document Collections

IC ID	Document Title	Status
219602	Order Form Form and Instruction	New
219601	Offering Circular Form and Instruction	New
219600	Proxy Statement Form and Instruction	New
19815	Application for Conversion Form and Instruction	Modified

ICR Details

OMB Control No: 7100-0335	ICR Reference No: 201601-7100-009
Status: Historical Active	Previous ICR Reference No: 201107-7100-004
Agency/Subagency: FRS	Agency Tracking No: Form 1680; Form 1681; Form 1682; Form 1683
Title: Application for Conversion; Proxy Statement; Offering Circular; Order Form
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Delegated
OIRA Conclusion Action: Approved without change	Conclusion Date: 01/27/2016
	Date Received in OIRA: 01/27/2016
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2019	36 Months From Approved	01/31/2016
Responses	40	0	30
Time Burden (Hours)	5,000	0	15,300
Cost Burden (Dollars)	0	0	0

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Abstract: Sections 5(i) (standard conversions) and 5(p) (supervisory conversions) of the Home Owners’ Loan Act (HOLA) authorize mutual to stock conversions. The four individual forms are all one-time submissions that are used by mutual holding companies requesting approval to convert to a stock institution.

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Authorizing Statute(s): US Code: 12 USC 1467a(o)(7) Name of Law: Home Owners' Loan Act
   US Code: 12 USC 1467a(b)(2) Name of Law: Home Owners' Loan Act
   US Code: 12 USC 1467a(g)(1) Name of Law: Home Owners' Loan Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 34641	06/17/2015
30-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 54790	09/11/2015
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 4

IC Title	Form No.	Form Name
Proxy Statement	Form 1681	Proxy Statement
Application for Conversion	Form 1680	Application for Conversion
Offering Circular	Form 1682	Offering Circular
Order Form	Form 1683	Order Form

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ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	40	30	0	0	10	0
Annual Time Burden (Hours)	5,000	15,300	0	0	-10,300	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: The decrease in total annual hours is due to an update in the number of respondents and estimated burden per response.

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Annual Cost to Federal Government: $0

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 01/27/2016

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