Information Collection

Schedule 13D -- Beneficial Ownership

IC 179039 under ICR 201001-1550-002 · OMB 1550-0019.

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IC Title:

Schedule 13D -- Beneficial Ownership

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 12 CFR 563d (To search for a specific CFR, visit the Code of Federal Regulations.)

Information Collection Instruments:

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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: 1

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	1	-1	2
Annual IC Time Burden (Hours)	3	-1	4
Annual IC Cost Burden (Dollars)	399	-1	400

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