Form 11-K

Forms and Documents

Document Name	Status
Form SEC 617 Form 11-K Form and Instruction	Unchanged
Form 11-K.ss.09.ext.doc Supporting Statement A	2009-07-29

IC Document Collections

IC ID	Document Title	Status
34320	Form 11-K Form and Instruction	Unchanged

ICR Details

OMB Control No: 3235-0082	ICR Reference No: 201207-3235-022
Status: Historical Inactive	Previous ICR Reference No: 200907-3235-019
Agency/Subagency: SEC	Agency Tracking No: CF-270-101
Title: Form 11-K
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Emergency	Approval Requested By: 07/31/2012
OIRA Conclusion Action: Withdrawn and continue	Conclusion Date: 07/26/2012
	Date Received in OIRA: 07/24/2012
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2012	2 Months From Approved	11/30/2012
Responses	2,000	0	2,000
Time Burden (Hours)	60,000	0	60,000
Cost Burden (Dollars)	0	0	0

---

Abstract: Section 15(d) of the Securities Exchange Act of 1934 (the "Exchange Act") establishes a periodic reporting obligation for every issuer of a class of securities registered under the Securities Act of 1933 (the "Securities Act"). Form 11-K is the annual report form designed for use by employee stock purchase, savings and similar plans to facilitate their compliance with that reporting requirement.

Emergency Justfication: We request a two month extension due to the lack of the division's resources that are currently prioritizing Dodd-Frank rule changes for the Commission. The 60 day FR notice is in process.

---

Authorizing Statute(s): US Code: 15 USC 78m, 78n, 78w(a) Name of Law: Securities Exchange Act of 1934
  

Citations for New Statutory Requirements: None

---

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

---

Federal Register Notices & Comments

Did the Agency receive public comments on this ICR? No

---

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

IC Title	Form No.	Form Name
Form 11-K	SEC 617	Form 11-K

---

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:

---

Annual Cost to Federal Government: $18,000

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

---

Common Form ICR:  No

---

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: 07/24/2012

---