Information Collection

Form 5 - Annual Statement of Beneficial Ownership

IC 34921 under ICR 201704-3235-008 · OMB 3235-0362.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3235-0362 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SEC 2270 Form 5 Annual Statement of Beneficial Ownership Form 5 - Annual Statement of Beneficial Ownership	Form
form5data,instructions.pdf www.sec.gov/files/form5data%2C0.pdf	Instruction
SEC 2270 Form 5 Annual Statement of Beneficial Ownership form5.4-30-2017.pdf www.sec.gov/files/form5.pdf	Form

IC Title:

Form 5 - Annual Statement of Beneficial Ownership

Agency IC Tracking Number:

CF 270-323

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 17 CFR 249.105

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	SEC 2270			https://www.sec.gov/files/form5.pdf	Yes	Yes	Fillable Fileable
Instruction				https://www.sec.gov/files/form5data%2C0.pdf	Yes	Yes	Fillable Fileable

Line of Business: Economic Development

Subfunction: Financial Sector Oversight

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 5,939

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	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	5,939	1,339	4,600
Annual IC Time Burden (Hours)	5,939	1,339	4,600
Annual IC Cost Burden (Dollars)	0	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.

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