Disclosure Form for Person Associated with a Financial Institution Securities Broker or Dealer

Notices Required of Government Securities Dealers or Brokers (Insured State Nonmember Banks)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3064-0093 can be found here:

Documents and Forms

Document Name Document Type
Form G-FIN-4 Disclosure Form for Person Associated with a Financial Institution Securities Broker or Dealer Form and Instruction
G-FIN-4 Disclosure Form for Person Associated with a Financial I G-FIN-4.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Disclosure Form for Person Associated with a Financial Institution Securities Broker or Dealer	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Mandatory

CFR Citation: 17 CFR Part 401 (To search for a specific CFR, visit the Code of Federal Regulations.)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	G-FIN-4	Disclosure Form for Person Associated with a Financial Institution Securities Broker or Dealer	G-FIN-4.pdf		Yes	No	Fillable Printable

Line of Business: Economic Development

Subfunction: Financial Sector Oversight

Privacy Act System of Records
Title: Professional Qualification Records for Municipal Securities Dealers, Municipal Securities Representatives and U.S. Government Securities Broker/Dealers	FR Citation: 80 FR 66982

Number of Respondents: 1	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	1	1
Annual IC Time Burden (Hours)	2	2
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.