Information Collection

Form 5 - Annual Statement of Beneficial Ownership

IC 34921 under ICR 202603-3235-014 · OMB 3235-0362.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SEC 2770T Form 5 Annual Statement of Beneficial Ownership Form 5 - Annual Statement of Beneficial Ownership	Form
SEC 2770T Form 5 Annual Statement of Beneficial Ownership form5.08-31-2026.pdf www.sec.gov/files/form5.pdf	Form

IC Title:

Agency IC Tracking Number:

Is this a Common Form? Yes

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 17 CFR 249.105

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	SEC 2770T			https://www.sec.gov/files/form5.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: 2,724

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
	Requested	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	2,724	-4,389	7,113
Annual IC Time Burden (Hours)	2,724	-4,389	7,113
Annual IC Cost Burden (Dollars)	0	0	0

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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