Information Collection

Rule 17a-12/Form X-17A-5 Part II

IC 273839 under ICR 202501-3235-024 · OMB 3235-0498.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form X-17A-5 Part II Rule 17a-12/Form X-17A-5 Part II	Form
Form X-17A-5 Part II X-17A-5 Part II Rule 17a-12/Form X-17A-5 Part II	Form
X-17A-5 Part II X-17A-5 Part II FOCUS Report Part II.pdf	Form
X-17A-5 Part II X-17A-5 Part II FOCUS Report Part II.pdf	Form

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Mandatory

CFR Citation: 17 CFR 240.17a-12

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	X-17A-5 Part II				Yes	Yes	Fillable Fileable Signable

Line of Business: Economic Development

Subfunction: Financial Sector Oversight

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 3

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	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	12	12
Annual IC Time Burden (Hours)	240	240
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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