NCUA 15003 Appraisal Complaint Form

OMB No. 3133-0200

Interagency Appraisal Complaint Form
Purpose: This form collects information about complaints of non-compliance with the appraisal independence
standards and the Uniform Standards of Professional Appraisal Practice, including complaints from appraisers,
individuals, financial institutions, and other entities.
Complaint Process: Your complaint will be reviewed by the appropriate regulator(s). Please do not submit
documents with your complaint, as the regulator(s) will contact you if more information is needed. Please note the
regulator(s) may not be able to provide the resolution you request because of legal and other constraints. For example,
regulator(s) considering a complaint do not have jurisdiction to directly award damages, settle fee disputes, or act as
your attorney or expert witness. A regulator’s review of your complaint will focus on potential violations of applicable
law or regulatory policy and could result in a regulator taking action(s) against the entity about which you are
complaining.
Paperwork Reduction Act of 1995: The burden for this collection of information is estimated to take 30 minutes
per response. This includes time for reviewing the instructions, gathering needed information, and completing and
reviewing the form. 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. If you have comments regarding this burden
estimate or any other aspect of this collection of information, including suggestions for reducing this burden, send
comments to: Legislative and Regulatory Activities Division, Office of the Comptroller of the Currency, Washington,
DC 20219; Comments/Legal ESS, Federal Deposit Insurance Corporation, 550 17th Street NW, Washington, DC
20429; NCUA PRA, National Credit Union Administration, 1775 Duke Street, Alexandria, Virginia 22314.
Privacy Notice: The information you are providing is being collected pursuant to the individual authorities of
the federal financial institution regulators (12 U.S.C. §§ 1, 481, 1464, 1756, 1766, and 1820 in connection with a
complaint made pursuant to 12 U.S.C. § 3351(i). The information provided will be used to ensure the appropriate
regulator receives your compliant and by the regulator to review and respond to your complaint. In order to review
and respond to your complaint, the appropriate regulator may disclose your information consistent with the routine
uses listed in the regulators’ respective Privacy Act statements:
OCC (www.helpwithmybank.gov/policies/policies-privacy.html);
FDIC (www.fdic.gov/consumers/questions/Priv_statement.html);
FRB (www.federalreserve.gov/privacy.htm); and
NCUA (www.mycreditunion.gov/Pages/privacy.aspx).
Do not include any information in your complaint you consider confidential or do not want disclosed during the
complaint review process. While completing this form is voluntary, failure to provide all of the information may delay
or prevent the appropriate regulator from reviewing your complaint.
Whistleblowers: Federal and state laws offer protection for whistleblowers.

Your Information
(

Name (First, Last or Business)
Address, City, State, Zip Code
Who are you? Please check the appropriate box.
 Individual Property Owner
 Business Property Owner
 Financial Institution Lender
 Non-Financial Institution Lender

) 

Phone

-

Email
 Mortgage Broker
 Appraiser
 Appraisal Management Company
 Other  

Who are you complaining about? Check all that apply.
 Appraiser
 Appraisal Management Company
 Lender
 Other 
Are you employed by the subject of your complaint?   Yes 
 No
NCUA Form 15003

Please provide information regarding the person or entity you are complaining about. If
more than one, please provide information in the “Describe your complaint” section, below.
(

Name (First, Last or Business)
Address, City, State, Zip Code
What is the nature of your complaint? Check all that apply.

) 

Phone

-

Email

 Appraiser independence
 Non-compliance with Uniform Standards of Professional Appraisal Practice
 Improper (or attempted improper) influencing of an appraiser or the appraisal process
 Removal or exclusion from an approved appraiser list or addition to a “do not use” list
 Appraisal fee-related issue
 Appraisal report inaccurate
 Other  
Please provide information about your complaint
Type of Property
 Residential 1-to-4 Family
 Commercial or Multi-Family (over 4 units)

Address of Property Involved

Have you tried to resolve your complaint with anyone?  Yes 
 No
If Yes, date of contact:
Who did you contact?
At what company or government agency?
Describe your complaint
Briefly describe your complaint. Do not submit any documents with your complaint. You will be
contacted if more information is needed.

For more information on appraiser independence or the Uniform Standards of Professional
Appraisal Practice (USPAP), go to: www.ReferMyAppraisalComplaint.gov.
I certify that I am the named individual or business (or their designee) filing this complaint and the
information in this complaint is true and correct to the best of my knowledge and belief.
Signature
NCUA Form 15003

Date