Form 5 - Annual Statement of Beneficial Ownership

ICR 202006-3235-008

OMB: 3235-0362

Federal Form Document

Forms and Documents
Document
Name
Status
Form
Modified
Supporting Statement A
2020-06-11
Supplementary Document
2020-06-11
Supplementary Document
2020-06-11
Supplementary Document
2020-06-05
IC Document Collections
IC ID
Document
Title
Status
34921 Modified
ICR Details
3235-0362 202006-3235-008
Active 201704-3235-008
SEC CF 270-323
Form 5 - Annual Statement of Beneficial Ownership
Extension without change of a currently approved collection   No
Regular
Approved without change 07/27/2020
Retrieve Notice of Action (NOA) 06/11/2020
  Inventory as of this Action Requested Previously Approved
07/31/2023 36 Months From Approved 07/31/2020
5,939 0 5,939
5,939 0 5,939
0 0 0

Form 5 is an annual statement of beneficial ownership used by officers, directors and ten percent shareholders of companies with securities registered under Section 12 of the Securities Exchange Act of 1934.

US Code: 15 USC 78l, 78p Name of Law: Securities Exchange Act of 1934
  
None

Not associated with rulemaking

  85 FR 14249 03/11/2020
85 FR 35348 06/09/2020
No

1
IC Title Form No. Form Name
Form 5 - Annual Statement of Beneficial Ownership SEC 2270 Form 5 Annual Statement of Beneficial Ownership

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 5,939 5,939 0 0 0 0
Annual Time Burden (Hours) 5,939 5,939 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$103,479,690
No
    No
    No
No
No
No
No
Sean Harrison 202 942-2910

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
06/11/2020


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