Form 5300 - Call Report - National Credit Union Administration (Page 3 of 29) in pdf

Form 5300 - Call Report - National Credit Union Administration Page 3

Credit Union Name:_____________________________ Federal Charter/Certificate Number:________________

CERTIFICATION OF NCUA 5300 CALL REPORT AS OF: _______________________

By signing below, I hereby certify the information being submitted is complete and accurate to the best of my

knowledge and has been certified by the person below. If submitted information is not accurate, I

understand I am required to submit a corrected Call Report upon notification or the discovery of a need for

correction. I understand false entries and reports or statements, including material omissions, with intent to

injure or defraud the credit union, the National Credit Union Administration, its examiners, or other

individuals or companies is punishable under 18 U.S.C. 1006.

Certifying Official:

Last Name:

Please Print

First Name:

Please Print

Last Name:

(Signature )

First Name:

(Signature )

Date:_________________________

Validation Date:_____________________

The instructions to prepare this form meet the requirement to provide guidance to small credit unions under

Section 212 of the Small Business Regulatory Enforcement Fairness Act of 1996.

You are not required to provide the information requested on a form that is subject to the Paperwork

Reduction Act unless the form displays a valid OMB control number.

Public reporting burden of this collection of information is estimated to average 6 hours per response,

including the time for reviewing instructions, searching existing data needed, and completing and reviewing

the collection of information. Send comments regarding this burden estimate or any other aspects of this

collection of information, including suggestions for reducing this burden to:

National Credit Union Administration

Office of the Chief Information Officer

1775 Duke Street

Alexandria, VA 22314-3428

NCUA 5300

Effective September 30, 2017

OMB No. 3133-0004

Previous Editions Are Obsolete

Form 5300 - Call Report - National Credit Union Administration Page 3