Form 5 - Annual Statement of Beneficial Ownership

Forms and Documents

Document	Type	Status	Availability
Form SEC 2770T Form 5 Annual Statement of Beneficial Ownership	Form	Modified	Available
3235-0362_30-Day Submission Notice.pdf.pdf	Supplementary Document	Uploaded 2026-06-22	Available
3235-0362_60-Day Collection Notice.pdf	Supplementary Document	Uploaded 2026-04-16	Available
Form 5.SupportingStatement.2026.pdf	Supporting Statement A	Uploaded 2026-04-10	Available
March 6, 2025.EDGAR PIA.pdf	Supplementary Document	Uploaded 2026-03-17	Available

IC Document Collections

IC ID	Collection	Type	Status	Form
34921	Form 5 - Annual Statement of Beneficial Ownership	Form	Modified	Form 5 Annual Statement of Beneficial Ownership

ICR Details

OMB Control No: 3235-0362	ICR Reference No: 202603-3235-014
Status: Received in OIRA	Previous ICR Reference No: 202602-3235-004
Agency/Subagency: SEC	Agency Tracking No: CF
Title: Form 5 - Annual Statement of Beneficial Ownership
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  Yes
Type of Review Request: Regular	Date Submitted to OIRA: 06/22/2026

	Requested	Previously Approved
Expiration Date	36 Months From Approved	08/31/2026
Responses	2,724	7,113
Time Burden (Hours)	2,724	7,113
Cost Burden (Dollars)	0	0

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Abstract: Congress enacted Section 16 of the Securities Exchange Act of 1934 (“Exchange Act”) to address insider trading. Pursuant to Section 16(a), every person who owns more than ten percent of any class of equity security (other than an exempted security) which is registered under Section 12 of the Exchange Act, or who is a director or an officer of the issuer of such security (collectively “reporting persons”) are required to file statements disclosing their ownership of the issuer’s equity securities. The Commission adopted Form 5 (17 CFR 249.105) pursuant to Section 16. Form 5 requires disclosure of certain information about a reporting person and their beneficial ownership of the relevant class of securities. A reporting person must file a Form 5 on or before the 45th day after the end of the issuer’s fiscal year end.

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Authorizing Statute(s): US Code: 15 USC 78p, 78w(a) Name of Law: Securities Exchange Act of 1934
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	91 FR 20527	04/16/2026
30-day Notice:	Federal Register Citation:	Citation Date:
	91 FR 37159	06/22/2026
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Form 5 - Annual Statement of Beneficial Ownership	SEC 2770T	Form 5 Annual Statement of Beneficial Ownership

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ICR Summary of Burden

	Total Request	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	2,724	7,113	0	0	-4,389	0
Annual Time Burden (Hours)	2,724	7,113	0	0	-4,389	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: The decrease in annual burden hours of 4,389 hours is due to a decrease in the estimated number of annual responses (from 7,113 to 2,724).

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Annual Cost to Federal Government:

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

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Common Form ICR:  Yes

Description/Changes for Common Form Usage:  The Securities and Exchange Commission (“Commission”) is submitting this Supporting Statement to request approval from the Office of Management and Budget (“OMB”) (1) for the extension of the existing collection of information (OMB Control No. 3235-0362) and (2) to designate OMB Control No. 3235-0362 as a “common form” for purposes of Paperwork Reduction Act (“PRA”) submissions because the Board of Governors of the Federal Reserve System uses this information collection (under OMB Control No. 7100-0091).

Approved RCFs using this ICR

Agency/Sub Agency	RCF ID	RCF Title	RCF Status	IC Title

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 06/22/2026

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