Form F-X

Forms and Documents

Document Name	Status
Form SEC-2288 Form F-X Form and Instruction	Modified
PRA supporting statement.5-5-2015.pdf Supporting Statement A	2015-05-05
secsorn1.pdf Supplementary Document	2015-05-05
EDGAR PIA_Redacted.pdf Supplementary Document	2014-08-08

IC Document Collections

IC ID	Document Title	Status
34949	Form F-X Form and Instruction	Modified

ICR Details

OMB Control No: 3235-0379	ICR Reference No: 201503-3235-021
Status: Historical Active	Previous ICR Reference No: 201408-3235-011
Agency/Subagency: SEC	Agency Tracking No: CF 270-336
Title: Form F-X
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 06/18/2015
	Date Received in OIRA: 05/06/2015
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2018	36 Months From Approved	06/30/2016
Responses	166	0	161
Time Burden (Hours)	332	0	322
Cost Burden (Dollars)	0	0	0

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Abstract: Form F-X is used to appoint an agent for service of process by Canadian issuers registering securities on Forms F-8,or F-10 under the Securities Act or filing periodic reports on Form 40-F under the Exchange Act, as well as in certain other circumstances.

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Authorizing Statute(s): US Code: 15 USC 77c(b), 77s, 77z-3 Name of Law: Securities Act of 1933
   US Code: 15 USC 78l, 78o, 78w(a), 78mm Name of Law: Securities Exchange Act of 1934
   US Code: 15 USC 77ddd Name of Law: Trust Indenture Act of 1939
  

Citations for New Statutory Requirements: PL: Pub.L. 112 - 106 401 Name of Law: Jumpstart Our Business Startups Act

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
3235-AL39	Final or interim final rulemaking	80 FR 21806	04/20/2015

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Federal Register Notices & Comments

Did the Agency receive public comments on this ICR? No

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

IC Title	Form No.	Form Name
Form F-X	SEC-2288	Form F-X

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ICR Summary 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	166	161	5	0	0	0
Annual Time Burden (Hours)	332	322	10	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	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: Form F-X is used to appoint an agent for service of process by Canadian issuers eligible to use Regulation A as well as in certain other circumstances. The adopted amendments to Regulation A do not change Form F-X itself, but we estimate that the approximately 5 issuers relying on adopted Regulation A and filing Form F-X annually will increase the current paperwork burden under Form F-X from 322 hours to 332 hours, an increase of 10 hours.

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Annual Cost to Federal Government: $100,000

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

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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: 05/06/2015

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