Bank Secrecy Act Suspicious Activity Report

Suspicious Activity Report by Insurance Companies

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1506-0029 can be found here:

Documents and Forms

Document Name Document Type
Form FinCEN Form 111 Bank Secrecy Act Suspicious Activity Report Form
FinCEN Form 111 Bank Secrecy Act Suspicious Activity Report BSA-SAR v37.3 (9-8-11).pdf Form

Information Collection (IC) Details

IC Title:	Bank Secrecy Act Suspicious Activity Report	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 31 CFR 1025.320

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	FinCEN Form 111	Bank Secrecy Act Suspicious Activity Report	BSA-SAR v37.3 (9-8-11).pdf		Yes	Yes	Fillable Fileable

Line of Business: Law Enforcement

Subfunction: Criminal Investigation and Surveillance

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: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	1	-3,599	3,600
Annual IC Time Burden (Hours)	1	-14,399	14,400
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.