Information Collection

19h-1(d) – Application for relief from certain statutory disqualifications

IC 218689 under ICR 202502-3235-005 · OMB 3235-0259.

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Information Collection (IC) Details

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IC Title:	19h-1(d) â Application for relief from certain statutory disqualifications	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 17 CFR 240.19h-1(d)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Line of Business: Economic Development

Subfunction: Financial Sector Oversight

Privacy Act System of Records
Title:	FR Citation:

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: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	3	-97	100
Annual IC Time Burden (Hours)	240	-7,760	8,000
Annual IC Cost Burden (Dollars)	0	0	0

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