Information Collection

Annual audited report

IC 258430 under ICR 202302-3235-005 · OMB 3235-0498.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3235-0498 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form X-17A-5 Part III Annual audited report	Form
X-17A-5 Part III X-17A-5 Part III Form X-17A-5 Part III.pdf www.sec.gov/about/forms/formx-17a-5_3.pdf	Form
X-17A-5 Part III X-17A-5 Part III Form X-17A-5 Part III.pdf www.sec.gov/about/forms/formx-17a-5_3.pdf	Form

IC Title:

Annual audited report

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Mandatory

CFR Citation: 17 CFR 240.17a-12

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
Form	X-17A-5 Part III	X-17A-5 Part III	Form X-17A-5 Part III.pdf	https://www.sec.gov/about/forms/formx-17a-5_3.pdf	Yes	Yes	Fillable Fileable

Line of Business: Economic Development

Subfunction: Financial Sector Oversight

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 3

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	3	3
Annual IC Time Burden (Hours)	300	300
Annual IC Cost Burden (Dollars)	138,900	138,900

Documents for IC

table that charts IC Documents
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.