Information Collection

Rule 6a-4 and Form 1-N

IC 35382 under ICR 202512-3235-021 · OMB 3235-0554.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SEC 2568 (11-02) Form 1-N Rule 6a-4 and Form 1-N	Form and Instruction
SEC 2568 (11-02) Form 1-N form1-n.pdf www.sec.gov/files/form1-n.pdf	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 17 CFR 240.6a-4

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 2568 (11-02)			https://www.sec.gov/files/form1-n.pdf	Yes	No	Printable Only

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: 0 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	3	1	2
Annual IC Time Burden (Hours)	45	15	30
Annual IC Cost Burden (Dollars)	327	127	200

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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