Information Collection

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

IC 235136 under ICR 201902-3064-008 · OMB 3064-0093.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
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

View Information Collection (IC)

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:

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	G-FIN-4	Disclosure Form for Person Associated with a Financial Institution Securities Broker or Dealer	G-FIN-4.pdf		Yes	No	Fillable Printable

Federal Enterprise Architecture Business Reference Module

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 %

table that charts list of burden
	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

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.