Interagency Bank Merger Act Application

Legal Form NumberFDIC 6220/01
SectionFederal Deposit Insurance Corporation
FDIC 6220/01 (7-21)
OMB No. for FDIC 3064-0015; Expiration Date: 07/31/2024
OMB No. for Federal Reserve 7100-0171; Expiration Date: 05/31/2024
OMB No. for OCC 1557-0014; Expiration Date: 01/31/2024
Federal Deposit Insurance Corporation
Public reporting burden for this collection of information is estimated to average 31 and 19 hours for nonaffiliate and
affiliate transactions, respectively, including the time to gather and maintain data in the required form, to review
instructions, and to complete the information collection. Send comments regarding this burden estimate or any other
aspect of this collection of information, including suggestions for reducing this burden to: Paperwork Reduction Act,
Legal Division, Federal Deposit Insurance Corporation (FDIC), 550 17th Street, NW, Washington, DC 20429; Secretary,
Board of Governors of the Federal Reserve System (Board), 20th and C Streets, NW, Washington, DC 20551; or
Licensing Activities Division, Office of the Comptroller of the Currency (OCC), 400 7th Street, SW, Washington, DC
20219 and to the Office of Management and Budget (OMB), Paperwork Reduction Project, Washington, DC 20503.
An organization or a person is not required to respond to a collection of information unless it displays a currently valid
OMB control number.
Preparation and Use
This application is used to effect a merger transaction under section 18(c) of the Federal Deposit Insurance Act (FDIA),
as amended (12 U.S.C. § 1828(c)), and for national banks using sources of merger authority, such as 12 U.S.C. §§ 215,
215a. “Merger transaction” includes a merger, consolidation, assumption of deposit liabilities, and certain asset transfers
between or among two or more institutions. An application is required for merger transactions between or among
affiliated institutions (affiliate transactions), as well as for merger transactions between or among nonaffiliated institutions.
An affiliate transaction refers to a merger transaction or other business combination (including a purchase and
assumption) between institutions that are commonly controlled (for example, between a depository institution and an
affiliated interim institution). Applicants proposing affiliate transactions are not required to complete questions 16 through
18 of this form.
All questions must be answered with complete and accurate information that is subject to verification. If the answer is
"none," "not applicable," “not available,” or "unknown," so state. Answers of “not available” or "unknown" should be
The questions in the application are not intended to limit the applicant's presentation, nor are the questions intended to
duplicate information supplied on another form or in an exhibit. A cross reference to the information is acceptable. Any
cross reference must be made to a specific location in the documents, so the information can be found easily.
Supporting information for all relevant factors, setting forth the basis for applicant's conclusions, should accompany the
application. The responsible regulatory agency may request additional information.
Applications involving insured depository institutions must be submitted to the responsible regulatory agency of the
depository institution that is the acquiring, assuming, or resulting institution (resultant institution). All questions about
preparing the merger application should be directed to that agency, along with the information requested in the
application and other information requested by the responsible agency. In addition, all applications involving a
noninsured bank or institution must be submitted to the FDIC.
For additional information regarding the processing procedures and guidelines and any supplemental information that
may be required, please refer to the responsible regulatory agency's procedural guidelines (for example, the OCC's
Rules and Regulations (12 C.F.R. Part 5), the Comptroller's Licensing Manual, the FDIC's Rules and Regulations (12
C.F.R. Part 303) and Statement of Policy on Bank Merger Transactions and other relevant policy statements. Contact the
responsible regulatory agency directly for specific instruction, or visit its website at,,

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