Non-index Filings

Hart-Scott-Rodino (Premerger notification) Rules and Report Form

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3084-0005 can be found here:

Documents and Forms

Document Name Document Type
Form C4 Non-index Filings Form
hsr_form_instructions_9-25-19.pdf www.ftc.gov/system/files/attachments/form-instructions/hsr_form_instructions_9-25-19.pdf Instruction
C4 Notification and Form for Certain Mergers and Acquisitio hsr_form_ver_102_-_01-02-17_0.pdf www.ftc.gov/system/files/attachments/form-instructions/hsr_form_ver_102_-_01-02-17_0.pdf Form

Information Collection (IC) Details

IC Title:	Non-index Filings	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 16 CFR 801 16 CFR 803 16 CFR 802

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	C4	Notification and Form for Certain Mergers and Acquisitions	hsr_form_ver_102_-_01-02-17_0.pdf	https://www.ftc.gov/system/files/attachments/form-instructions/hsr_form_ver_102_-_01-02-17_0.pdf	Yes	Yes	Fillable Fileable Signable
Instruction			hsr_form_instructions_9-25-19.pdf	https://www.ftc.gov/system/files/attachments/form-instructions/hsr_form_instructions_9-25-19.pdf	No		Printable Only

Line of Business: Economic Development

Subfunction: Business and Industry Development

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 4,894	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 20 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	4,894	341	4,553
Annual IC Time Burden (Hours)	181,078	12,617	168,461
Annual IC Cost Burden (Dollars)	0	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.