Designation of Exempt Person

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

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

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Designation of Exempt Person	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

Obligation to Respond: Mandatory

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

Information Collection 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 %

	Requested	Previously Approved
Annual Number of Responses for this IC	64,999	64,999
Annual IC Time Burden (Hours)	97,499	97,499
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.