Information Collection

Form 5 - Annual Statement of Beneficial Ownership

IC 34921 under ICR 202602-3235-004 · OMB 3235-0362.

Documents and Forms

Document Name Document Type
Form SEC 2770T Form 5 Annual Statement of Beneficial Ownership Form 5 - Annual Statement of Beneficial Ownership Form
form5data.08-31-2026.pdf www.sec.gov/files/form5data%2C0.pdf Instruction
SEC 2770T Form 5 Annual Statement of Beneficial Ownership form5.08-31-2026.pdf www.sec.gov/files/form5.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Form 5 - Annual Statement of Beneficial Ownership	Agency IC Tracking Number:	CF

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 17 CFR 249.105

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SEC 2770T	Form 5 Annual Statement of Beneficial Ownership	form5.08-31-2026.pdf	https://www.sec.gov/files/form5.pdf	Yes	Yes	Fillable Fileable
Instruction			form5data.08-31-2026.pdf	https://www.sec.gov/files/form5data%2C0.pdf	Yes	Yes	Fillable Fileable

Line of Business: Economic Development

Subfunction: Financial Sector Oversight

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 7,113	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to New Statute	Previously Approved
Annual Number of Responses for this IC	7,113	1,174	5,939
Annual IC Time Burden (Hours)	7,113	1,174	5,939
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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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