Information Collection

IC15 - 17Ad-22(e)(4) (for respondent not registered)

IC 238111 under ICR 202207-3235-014 · OMB 3235-0695.

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Information Collection (IC) Details

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IC Title:	IC15 - 17Ad-22(e)(4) (for respondent not registered)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 17 CFR 240.17Ad-22(e)(4)

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: 1	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	1	0	-1	2
Annual IC Time Burden (Hours)	135	0	-135	270
Annual IC Cost Burden (Dollars)	322,080	-322,080	0	644,160

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.