Information Collection

Form 4 - Statement of Changes in Beneficial Ownership of Securities

IC 34761 under ICR 200711-3235-003 · OMB 3235-0287.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3235-0287 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SEC 1474 Form 4 - Statement of Changes in Beneficial Ownership of Securities	Form
SEC 1474 Form 4 SEC 1474form4.pdf www.sec.gov/about/forms/form4.pdf	Form
SEC 1475 Form 4 SEC 1475form4data.pdf www.sec.gov/about/forms/form4data.pdf	Form

IC Title:

Form 4 - Statement of Changes in Beneficial Ownership of Securities

Agency IC Tracking Number:

270-126

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 17 CFR 249.104

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SEC 1474	Form 4	SEC 1474form4.pdf	http://www.sec.gov/about/forms/form4.pdf	Yes	Yes	Fillable Fileable
Form	SEC 1475	Form 4	SEC 1475form4data.pdf	http://www.sec.gov/about/forms/form4data.pdf	Yes	Yes	Fillable Fileable

Line of Business: Economic Development

Subfunction: Financial Sector Oversight

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 225,000

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	225,000	225,000
Annual IC Time Burden (Hours)	112,500	112,500
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.