Information Collection

Reporting of missing, lost, stolen or counterfeit securities (17 CFR Section 240.17f-1(c); Form X-17F-1A (17 CFR Section 249.100)

IC 34104 under ICR 200911-3235-013 · OMB 3235-0037.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3235-0037 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form X-17f-1a.pdf Form X-17f-1a	IC Document

IC Title:

Reporting of missing, lost, stolen or counterfeit securities (17 CFR Section 240.17f-1(c); Form X-17F-1A (17 CFR Section 249.100)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 17 CFR 240.17f-1(c) 17 CFR 249.100

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

Line of Business: Economic Development

Subfunction: Financial Sector Oversight

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 26,000

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 90 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	1,300,000	1,300,000
Annual IC Time Burden (Hours)	108,333	108,333
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Form X-17f-1a	Form X-17f-1a.pdf	11/12/2009

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