12 CFR Appendix A to Part 1522: Appendix A to Part 1522—Attestation for an Initial Certification Under Section 4(c) of the GENIUS Act

Attestation for an Initial Certification Under Section 4(c) of the GENIUS Act

State: _____

Name of State payment stablecoin regulator: _____

Date of attestation: _____

[States may include a brief introduction here]

Reference table of requirements, narrative, and supporting information:

GENIUS Act section Topic Corresponding section of narrative Corresponding supporting information

4(a)(1)(A), except as noted below Reserve assets [Section X] [Exhibit A].

4(a)(1)(A)(vii) Additional reserve assets

4(a)(1)(B), except as noted below Redemption

4(a)(1)(B)(i) Discretionary limitations on timely redemptions

4(a)(1)(C) Monthly publication of reserves

4(a)(2), except as noted below Prohibition on rehypothecation of reserves

4(a)(2)(C)(ii) Approval for rehypothecation of reserves

4(a)(3)(A), (C) Independent accountant examination of reports

4(a)(3)(B) Monthly CEO/CFO certification of accuracy of reserve report

4(a)(4) Capital, liquidity, reserve asset diversification, and risk-management standards

4(a)(5) Bank Secrecy Act/sanctions compliance program requirements

4(a)(6)(B) Technological capability to comply with, and obligation to comply with, terms of lawful orders

4(a)(7)(A) Limitation on permitted payment stablecoin activities

4(a)(7)(B) Additional permitted payment stablecoin activities

4(a)(8) Prohibition on tying

4(a)(9) Prohibition on deceptive names

4(a)(10) Audits and reports

4(a)(11) Prohibition on paying interest/yield on stablecoins

4(a)(12) Limits on non-financial public companies (and certain foreign companies) issuing stablecoins

4(d) Transition to Federal oversight

5 Application and approval

6 Supervision and enforcement

10 Custody

11 Insolvency

Primary contacts: [Names, titles, email addresses, and phone numbers of at least two authorized officials of the State payment stablecoin regulator]

Certification:

The undersigned hereby certifies and attests that:

1. The information contained in and attached to this attestation form is true and correct to the best of the undersigned's knowledge;

2. The State-level regulatory regime for the State named above meets each of the principles for substantial similarity established by the Department of the Treasury pursuant to section 4(c) of the Act (as codified at 12 CFR part 1521), including that it:

a. _____ meets or exceeds the standards and requirements under section 4(a) of the Act in accordance with Treasury's principles;

b. _____ provides for transition to Federal oversight in accordance with Treasury's principles;

c. _____ provides for application and licensing in accordance with Treasury's principles;

d. _____ provides for supervision and enforcement in accordance with Treasury's principles;

e. _____ provides for custody in accordance with Treasury's principles;

f. _____ provides for the event of insolvency in accordance with Treasury's principles; and

g. _____ provides additional State requirements only to the extent permitted by Treasury's principles; and

3. The undersigned has the authority to submit this attestation and make the representations herein on behalf of the State payment stablecoin regulator named above.

_____ The above certifications and attestations are conditional on additional actions that are described in the attached narrative, and the State payment stablecoin regulator intends to amend this attestation once those actions are completed. The undersigned acknowledges on behalf of the State payment stablecoin regulator that the Committee will not process this conditional attestation unless and until an amended attestation has been submitted in accordance with 12 CFR 1522.10.

_____ The undersigned believes that the State listed above qualifies for expedited processing under 12 CFR 1522.10(e) and has included an associated statement in the attached narrative and attached any supporting documentation, as appropriate.

[Signature, Name, Title]

Attached:

[Narrative]

[Exhibits]