Information Collection

Form 5 - Annual Statement of Beneficial Ownership

IC 34921 under ICR 201010-3235-025 · OMB 3235-0362.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3235-0362 can be found here:

Documents and Forms

Document Name Document Type
Form SEC 2270 Form 5 - Annual Statement of Beneficial Ownership Form
SEC2270form5data.General Instructions.pdf www.sec.gov/about/forms/form5data.pdf Instruction
SEC 2270 Form 5 SEC2270.form5(a).Statement.pdf www.sec.gov/about/forms/form5.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Form 5 - Annual Statement of Beneficial Ownership	Agency IC Tracking Number:	CF 270-323

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 17 CFR 249.105

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SEC 2270	Form 5	SEC2270.form5(a).Statement.pdf	http://www.sec.gov/about/forms/form5.pdf	Yes	Yes	Fillable Fileable
Instruction			SEC2270form5data.General Instructions.pdf	http://www.sec.gov/about/forms/form5data.pdf	Yes	Yes	Fillable Fileable

Line of Business: Economic Development

Subfunction: Financial Sector Oversight

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 9,000	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	9,000	9,000
Annual IC Time Burden (Hours)	9,000	9,000
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.