Information Collection

Reports by insurance companies of suspicious transactions

IC 15337 under ICR 202405-1506-010 · OMB 1506-0029.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form FinCEN 111 Reports by insurance companies of suspicious transactions	Form and Instruction
Form FinCEN 111 Suspicious Activity Report Reports by insurance companies of suspicious transactions	Form and Instruction
FinCEN 111 Suspicious Activity Report FinCEN SAR.pdf bsaefiling.fincen.treas.gov/main.html	Form and Instruction
FinCEN 111 Suspicious Activity Report FinCEN SAR.pdf bsaefiling.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 1025.320

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 111			http://bsaefiling.fincen.treas.gov/main.html	Yes	Yes	Fillable Fileable

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.

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