IC11 - SIPC Annual Assessment Reconciliation Form or Certification of Exclusion from Membership Form

Rule 17a-5, Form X-17A-5 (FOCUS REPORT)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3235-0123 can be found here:

Documents and Forms

Document Name Document Type

no available documents/forms check other ICs listed under this ICR

Information Collection (IC) Details

IC Title:	IC11 - SIPC Annual Assessment Reconciliation Form or Certification of Exclusion from Membership Form	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 17 CFR 240.17a-5

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Line of Business: Economic Development

Subfunction: Financial Sector Oversight

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 3,689	Number of Respondents for Small Entity: 895

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

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	3,689	-369	4,058
Annual IC Time Burden (Hours)	18,445	-1,845	20,290
Annual IC Cost Burden (Dollars)	1,845	-62	1,907

Documents for IC

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Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.