Information Collection

Rule 17a-12 – Annual Audited Report and Supporting Schedules

IC 273840 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 III Rule 17a-12 – Annual Audited Report and Supporting Schedules	Form
Form X-17A-5 Part III X-17A-5 Part III Rule 17a-12 – Annual Audited Report and Supporting Schedules	Form
X-17A-5 Part III X-17A-5 Part III FOCUS Report Part III.pdf	Form
X-17A-5 Part III X-17A-5 Part III FOCUS Report Part III.pdf	Form

IC Title:

Rule 17a-12 â Annual Audited Report and Supporting Schedules

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 III				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	3	3
Annual IC Time Burden (Hours)	300	300
Annual IC Cost Burden (Dollars)	138,900	138,900

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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