Form FR 2004SI FR 2004SI Weekly Report of Specific Issues

FR 2004SI

Weekly Report of Specific Issues

OMB No. 7100-0003
Average Hours per Response: 2
Approval Expires February 28, 2010

as of close of trading on Wednesday: ________________
(millions of dollars at par value)
Gross Financing
Securities In

Security
1

Cumulative
Outright
Transactions
2

Specific Transactions
Net Settled
Position
3

ON/open
4

Term
5

Securities Out
General

ON/open
6

Specific Transactions
Term
7

ON/open
8

Term
9

Fails
General

ON/open
10

Term
11

to Receive
12

to Deliver
13

FRBNY
Security
ID
14

1

2

2

3

3

5

4

10

5

30

6

55

7

60

8

70

9

80

10
Total
Return by 4:00 pm the following business day to:
Government Securities Dealer Statistics Unit

name of preparer:
telephone #:

Federal Reserve Bank of New York
33 Liberty Street
Fourth Floor

dealer name:
comments:

New York, NY 10045
Facsimile number (212) 720-5030 or (646) 720-5030
“To the best of my knowledge, the report has been prepared in conformity with the instructions issued by the Federal Reserve Bank of New York and is accurate. I am responsible for the internal controls over the reporting of the data in
this report and believe that these controls are effective. These internal controls are (1) designed to ensure the accuracy of this data, (2) monitored and reviewed by audit or compliance staff, and (3) assessed regularly by management of
the named institution. I agree to report any material deficiencies in these internal controls and any inaccuracies in data already reported to the Federal Reserve Bank of New York.”
Note: Dealers are only required to submit a copy of this attestation with the last as-of date of each year.
Name __________________________________________________________________

Title _________________________________________________________

Signature _______________________________________________________________

Date _________________________________________________________