Form N-4 Under the Investment Company Act of 1940 and the Securities Act of 1933

ICR 200003-3235-027

OMB: 3235-0318

Federal Form Document

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Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
ICR Details
3235-0318 200003-3235-027
Historical Active 199707-3235-007
SEC
Form N-4 Under the Investment Company Act of 1940 and the Securities Act of 1933
Extension without change of a currently approved collection   No
Regular
Approved without change 04/14/2000
Retrieve Notice of Action (NOA) 03/14/2000
  Inventory as of this Action Requested Previously Approved
04/30/2003 04/30/2003 04/30/2000
1,244 0 288
284,379 0 40,562
25,063,000 0 0

Form N-4 is the required form that insurance company separate accounts organized as unit investment trusts must use in order to meet the regulatory requirements imposed on entities offering variable annuity contracts. This form satisfies the registration requirements of the Investment Company Act of 1940 and the Securities Act of 1933.

None
None


No

1
IC Title Form No. Form Name
Form N-4 Under the Investment Company Act of 1940 and the Securities Act of 1933 SEC2125

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 1,244 288 0 956 0 0
Annual Time Burden (Hours) 284,379 40,562 0 243,817 0 0
Annual Cost Burden (Dollars) 25,063,000 0 0 0 25,063,000 0
Yes
No

$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
03/14/2000


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