Information Collection

Form 1-SA

IC 212628 under ICR 201905-3235-004 · OMB 3235-0721.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3235-0721 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SEC 2914 Form 1-SA	Form and Instruction
SEC 2914 Form 1-SA form1-sa.10-31-2021.pdf www.sec.gov/files/form1-sa.pdf	Form and Instruction

IC Title:

Form 1-SA

Agency IC Tracking Number:

CF 270-661

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 17 CFR 239.92

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 2914	Form 1-SA	form1-sa.10-31-2021.pdf	https://www.sec.gov/files/form1-sa.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: 55

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	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	55	0	55
Annual IC Time Burden (Hours)	8,791	28	8,763
Annual IC Cost Burden (Dollars)	618,420	0	618,420

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.