Information Collection

Disclosure Form 4 (17 CFR 240.16a-3(k))

IC 240087 under ICR 202302-7100-008 · OMB 7100-0091.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type

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IC Title:

Disclosure Form 4 (17 CFR 240.16a-3(k))

Agency IC Tracking Number:

FR H-1

Is this a Common Form? No

IC Status: Unchanged

Obligation to Respond: Mandatory

CFR Citation: 12 CFR 208.36 17 CFR 240.16a-3(k)

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: 2

Number of Respondents for Small Entity: 1

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	70	70
Annual IC Time Burden (Hours)	35	35
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.

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