Non-index Filings

Hart-Scott-Rodino (Premerger notification) Rules and Report Form

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3084-0005 can be found here:

Documents and Forms

Document Name Document Type
Form C4 Non-index Filings Form
HSR Proposed Revised Notification Form Instructions.pdf Instruction
C4 Notification and Report Form for Certain Mergers and Acq HSR Proposed Revised Notification Form.pdf Form

Information Collection (IC) Details

IC Title:	Non-index Filings	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 16 CFR 802 16 CFR 803 16 CFR 801

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	C4	Notification and Report Form for Certain Mergers and Acquisitions (DRAFT)	HSR Proposed Revised Notification Form.pdf		Yes	Yes	Fillable Fileable Signable
Instruction			HSR Proposed Revised Notification Form Instructions.pdf		Yes	No	Printable Only

Line of Business: Economic Development

Subfunction: Business and Industry Development

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 841	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	841	421	420
Annual IC Time Burden (Hours)	31,117	14,737	16,380
Annual IC Cost Burden (Dollars)	0	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.