Information Collection

File Withdrawal Form

IC 199814 under ICR 201110-3235-012 · OMB 3235-0696.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3235-0696 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SBSE-W File Withdrawal Form	Form
SBSE-W Form SBSE-W 34-65543-sbse-w.pdf www.sec.gov	Form

IC Title:

File Withdrawal Form

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Mandatory

CFR Citation: 17 CFR 249.1601 17 CFR 240.15Fb3-1

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SBSE-W	Form SBSE-W	34-65543-sbse-w.pdf	http://www.sec.gov	Yes	Yes	Fillable Fileable Signable

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: 100 %

table that charts list of burden
	Requested	Program Change Due to New Statute
Annual Number of Responses for this IC	1	1
Annual IC Time Burden (Hours)	1	1
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.