Information Collection

Third Party or Designated Executive Officer Undertaking

IC 258124 under ICR 202301-3235-027 · OMB 3235-0279.

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Documents and Forms

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IC Title:

Third Party or Designated Executive Officer Undertaking

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Mandatory

CFR Citation: 17 CFR 240.17a-4

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

Line of Business: Economic Development

Subfunction: Financial Sector Oversight

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 3,333

Number of Respondents for Small Entity: 2,590

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 95 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,111	1,111
Annual IC Time Burden (Hours)	1,111	1,111
Annual IC Cost Burden (Dollars)	552,167	552,167

Documents for IC

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