Information Collection

Designation of Exempt Person

IC 15300 under ICR 200812-1506-001 · OMB 1506-0012.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1506-0012 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 110 Designation of Exempt Person	Form
110 Designation of Exempt Person fin110_dep.pdf www.fincen.gov/fin110_dep.pdf	Form

IC Title:

Designation of Exempt Person

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 31 CFR 103.22(d)(2)

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	110	Designation of Exempt Person	fin110_dep.pdf	www.fincen.gov/fin110_dep.pdf	Yes	Yes	Fillable Fileable

Line of Business: Law Enforcement

Subfunction: Crime Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 19,000

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 45 %

table that charts list of burden
	Approved	Program Change Due to New Statute	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	64,999	20,001	-40,002	85,000
Annual IC Time Burden (Hours)	97,499	0	-242,501	340,000
Annual IC Cost Burden (Dollars)	0	0	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.