Information Collection

Form T-4 Application For Exemption

IC 34363 under ICR 201512-3235-014 · OMB 3235-0107.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3235-0107 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SEC-1920 Form T-4 Application For Exemption	Form and Instruction
SEC-1920 Form T-4 formt-4.12-31-2015.pdf www.sec.gov/about/forms/formt-4.pdf	Form and Instruction

IC Title:

Form T-4 Application For Exemption

Agency IC Tracking Number:

CF 270-124

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 17 CFR 269.4

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 and Instruction	SEC-1920	Form T-4	formt-4.12-31-2015.pdf	http://www.sec.gov/about/forms/formt-4.pdf	Yes	Yes	Fillable Fileable

Line of Business: Economic Development

Subfunction: Financial Sector Oversight

Privacy Act System of Records

Title: (SEC 3) Notification of Exemption from Registration under the Securities Act of 1933

FR Citation: 41 FR 41550

Number of Respondents: 3

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
	Approved	Previously Approved
Annual Number of Responses for this IC	3	3
Annual IC Time Burden (Hours)	3	3
Annual IC Cost Burden (Dollars)	4,800	4,800

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.