Information Collection

Form X-17F-1A

IC 34104 under ICR 202409-3235-021 · OMB 3235-0037.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SEC 1666 Form X-17F-1A	Form and Instruction
Form SEC 1666 Form X-17F-1A Form X-17F-1A	Form and Instruction
SEC 1666 Form X-17F-1A formx-17f-1a.pdf www.sec.gov/about/forms/formx-17f-1a.pdf	Form and Instruction
SEC 1666 Form X-17F-1A formx-17f-1a.pdf www.sec.gov/about/forms/formx-17f-1a.pdf	Form and Instruction

IC Title:

Form X-17F-1A

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 17 CFR 249.100 17 CFR 240.17f-1(c)

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	SEC 1666			http://www.sec.gov/about/forms/formx-17f-1a.pdf	No		Paper Only

Line of Business: Economic Development

Subfunction: Financial Sector Oversight

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 115

Number of Respondents for Small Entity: 112

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 90 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	3,450	-299,550	303,000
Annual IC Time Burden (Hours)	288	-24,962	25,250
Annual IC Cost Burden (Dollars)	0	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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