Bank Name:
_______________________________
Charter: ________________
Please note the following reporting requirements
for Independent Credit Card Banks:
Currently receivables attributable (as defined
below) is not a separately reported amount included in the regular quarterly
call report. In order to comply with the independent credit card assessment
that applies to this component, it is necessary for you to provide the
following information.
Total off balance sheet receivables attributable (in $ millions) to
credit card accounts owned by your institution as of the call date, June
30, 2004. Where there are no
receivables meeting this requirement indicate NONE.
__________________________________________
Signed Name:
________________________________ Phone Number ________________
Printed name: _________________________________
Prior
to the due date of July 31, 2004, please FAX this completed form to: Revenue
Accounting (202) 874-5171
Receivables attributable is the total amount of outstanding balances due
on credit card accounts owned by an independent credit card bank (the
receivables attributable to those accounts) on the last day of the assessment
period, minus receivables retained on the bank’s balance sheet as of that day.
For specific questions concerning assessments,
please call our 24-hour, toll free number at 866-874-5150. Leave a detailed message and a staff member
will return your call promptly.