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Federal Deposit Insurance Corporation 

LARGE-BANK DEPOSIT INSURANCE DETERMINATION MODERNIZATION 

ANNUAL QUESTIONNAIRE

INSTRUCTIONS: Pursuant to the FDIC Large-Bank Deposit Insurance Determination Modernization rule (12 C.F.R. §360.9), you are 

required to complete an annual questionnaire. Fill out this form and return to the FDIC, no later than March 31st.

Questionnaire Year: NOTE: Covers January 1st - December 31st of the previous year.

SECTION I - INSTITUTION INFORMATION

1. Case Number 2. Covered Institution (CI) Name 3. FDIC Certificate Number

4. Address (Street, City, State, ZIP Code)

SECTION II - DEPOSIT-HOUSING SYSTEM INFORMATION

5. Enter the Software Vendor, Platform, Version, and Type of Account(s) below.

Software Vendor Software Platform Software Version Type of Account(s)

SECTION III - QUESTIONNAIRE

6. Do any of the deposit system platforms listed in Question 5 have an approved exemption? Yes No

If yes, which platforms and dates?

7. Are all deposit-housing systems able to implement automated provisional holds and generate standardized data files from the 

production environment? Yes No

If no, explain which deposit systems are not capable?

8. What was the results and the date of the last self-assessment? Pass Fail Last Self-Assessment Date:

9. Did the CI have major changes on deposit systems? Yes No

Comments (If Applicable)

10. Did the CI acquire/merge with another financial institution? Yes No

a. If yes, did the CI convert all accounts onto existing deposit systems? Yes No

b. If no to 10a, explain.

11. Did the CI introduce new deposit or sweep investment products? Yes No

Comments (If Applicable)

12. Does the CI have brokered deposits? Yes No
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If yes, name the system and number of brokers.

13. Does the CI have Total Bank Solutions Insured Cash Sweep or IntraFi Network Deposits, formerly called Promontory Insured 

Cash Sweep and CDARS? Yes No

If yes, name the system and number of participating accounts.

14. Does the CI have prepaid card products? Yes No

If yes, name the program manager and processor.

15. Does the CI have debit card products? Yes No

If yes, name the program manager and processor.

16. Does the CI partner with third-party FinTech entities that provide deposit account services exclusively online and mobile 

app, i.e., neo-bank? Yes No

If yes, name the third-party entities.

SECTION IV - INSTITUTION CONTACTS

17. The final rule requires a Covered Institution to notify the FDIC of the person(s) responsible for producing the standard deposit data 

download and administering provisional holds, both while this functionality is being constructed and on an on-going basis. The Covered 

Institution is responsible for ensuring such contact information is current.

Point of Contact Name Title Telephone Email Address

Primary

Compliance

Information 

Technology

Deposit 

Operations

Financial 

Reporting

Technology 

Service Provider

SECTION V - COVERED INSTITUTION OFFICER SIGNATURE

18. Name 19. Title

20. Signature 21. Date