Information Collection

Reports by brokers or dealers in securities, mutual funds, & futures commission merchants and introducing commodities of suspicious transactions

IC 39059 under ICR 202405-1506-009 · OMB 1506-0019.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form FinCEN Form 111 Reports by brokers or dealers in securities, mutual funds, & futures commission merchants and introducing commodities of suspicious transactions	Form and Instruction
FinCEN Form 111 Bank Secrecy Act Suspicious Activity Report SuspiciousActivityReport.pdf sdtmut.fincen.treas.gov/main.html	Form and Instruction
FinCEN Form 111 Bank Secrecy Act Suspicious Activity Report SuspiciousActivityReport.pdf sdtmut.fincen.treas.gov/main.html	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 31 CFR 1026.320 31 CFR 1024.320 31 CFR 1023.320

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 and Instruction	FinCEN Form 111	Bank Secrecy Act Suspicious Activity Report	SuspiciousActivityReport.pdf	http://sdtmut.fincen.treas.gov/main.html	Yes	Yes	Fillable Fileable Signable

Line of Business: Law Enforcement

Subfunction: Criminal Investigation and Surveillance

Privacy Act System of Records

Title: FinCEN Privacy Act System of Records Notice

FR Citation: 79 FR 20969

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 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	1	1
Annual IC Time Burden (Hours)	1	1
Annual IC Cost Burden (Dollars)	0	0

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.