Form N-4 (17 CFR 239.17b) under the Securities Act of 1933 and (17 CFR 274.11c) under the Investment Company Act of 1940, registration statement of separate accounts organized as unit investment trust

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form SEC 2125 Form N-4 (17 CFR 239.17b) under the Securities Act of 1933 and (17 CFR 274.11c) under the Investment Company Act of 1940, registration statement of separate accounts organized as unit investment trust	Form	Modified	Available
N-4 Supporting Statement 2012.pdf	Supporting Statement A	Uploaded 2012-07-23	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
34837	Form N-4 (17 CFR 239.17b) under the Securities Act of 1933 and (17 CFR 274.11c) under the Investment Company Act of 1940, registration statement of separate accounts organized as unit investment trust	Form	Modified

ICR Details

OMB Control No: 3235-0318	ICR Reference No: 201207-3235-005
Status: Historical Active	Previous ICR Reference No: 200907-3235-005
Agency/Subagency: SEC	Agency Tracking No: IM-270-282
Title: Form N-4 (17 CFR 239.17b) under the Securities Act of 1933 and (17 CFR 274.11c) under the Investment Company Act of 1940, registration statement of separate accounts organized as unit investment trust
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 09/12/2012
	Date Received in OIRA: 07/23/2012
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2015	36 Months From Approved	11/30/2012
Responses	1,251	0	1,464
Time Burden (Hours)	256,835	0	297,224
Cost Burden (Dollars)	26,609,241	0	29,428,280

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Abstract: Form N-4 is the form separate accounts organized as unit investment trusts that offer variable annuities use to register under the Investment Company Act of 1940 and to offer their securities under the Securities Act of 1933.

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Authorizing Statute(s): US Code: 15 USC 77e Name of Law: Securities Act of 1933
   US Code: 15 USC 80a-8 Name of Law: Investment Company Act of 1940
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 27101	05/08/2012
30-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 41461	07/13/2012
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
Form N-4 (17 CFR 239.17b) under the Securities Act of 1933 and (17 CFR 274.11c) under the Investment Company Act of 1940, registration statement of separate accounts organized as unit investment trust	SEC 2125	Form N-4

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	1,251	1,464	0	0	-213	0
Annual Time Burden (Hours)	256,835	297,224	0	0	-40,389	0
Annual Cost Burden (Dollars)	26,609,241	29,428,280	0	0	-2,819,039	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: Currently, the approved total annual time burden for preparing and filing registration statements on Form N-4 is 297,224 hours and the total annual cost burden allocated to Form N 4 is $29,428,280. These burdens were based on the previous estimate of 1,464 total annual responses (104 initial responses + 1,360 post-effective amendments = 1,464 total annual responses). The new estimate of the total annual hour burden is 256,834.75 hours and the new estimate of the total annual cost burden is $26,609,241. These new burdens are based on the new estimated total annual number of responses of 1,251 (124 initial responses + 1,127 post-effective amendments = 1,251 total annual responses). The decrease to the total annual hour burden of 40,389.25 hours and the decrease to the total annual cost burden of $2,819,039 are due to a decrease in estimated responses representing post-effective amendments, offset slightly by an increase in the estimated number of responses representing initial filings.

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Annual Cost to Federal Government: $0

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 07/23/2012

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