Form 5 - Annual Statement of Beneficial Ownership

Forms and Documents

Document Name	Status
Form SEC 2270 Form 5 - Annual Statement of Beneficial Ownership Form	Modified
Release 33-11030.Supporting Statement.FinalFinal.pdf Supporting Statement A	2023-08-24
March 22, 2023 EDGAR PIA.pdf Supplementary Document	2023-08-23

IC Document Collections

IC ID	Document Title	Status
34921	Form 5 - Annual Statement of Beneficial Ownership Form	Modified

ICR Details

OMB Control No: 3235-0362	ICR Reference No: 202308-3235-021
Status: Received in OIRA	Previous ICR Reference No: 202307-3235-013
Agency/Subagency: SEC	Agency Tracking No: CF 270-323
Title: Form 5 - Annual Statement of Beneficial Ownership
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 08/24/2023

	Requested	Previously Approved
Expiration Date	36 Months From Approved	08/31/2026
Responses	6,533	5,939
Time Burden (Hours)	6,533	5,939
Cost Burden (Dollars)	0	0

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Abstract: 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.

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Authorizing Statute(s): US Code: 15 USC 78c(a), 78c(b), 78m, 78p Name of Law: Securities Exchange Act of 1934
   US Code: 15 USC 78w(a) Name of Law: Securities Exchange Act of 1934
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
3235-AM93	Proposed rulemaking	87 FR 13846	03/10/2022

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Federal Register Notices & Comments

Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

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

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ICR Summary of Burden

	Total Request	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	6,533	5,939	0	594	0	0
Annual Time Burden (Hours)	6,533	5,939	0	594	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Changing Regulations

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: As explained in further detail in Items 1, 2, 12 and 13 above, changes in burden for Schedules 13D and 13G and Forms 3, 4 and 5 would result from the proposed amendments to Rules 13d-2(b), 13d-3, 13d-5 and Item 6 of Schedule 13D. These amendments were proposed in order to modernize the Commission’s beneficial ownership reporting rules. We estimate that the proposed amendments would increase the burdens associated with Regulation 13D-G and the burdens associated with Forms 3, 4 and 5. For purposes of the PRA, we estimate that the proposed amendments would result in an increase of 594 annual responses for Form 5, an increase of 594 burden hours for Form 5 and an increase in the cost burden of $0 for the services of outside professionals for Form 5.

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Annual Cost to Federal Government: $129,168,390

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

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Common Form ICR:  No

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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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 08/24/2023

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