OMB.report

Federal forms, ICRs, and supporting documents

OMB control number

Annuity Broker Qualification Declaration Form

OMB 1105-0080 ยท DOJ/LA.

OMB 1105-0080

This declaration is to be submitted to determine whether a broker meets the minimum qualifications to be listed as an annuity broker pursuant to Section 11015(b) of Public Law 107-273.

The latest form for Annuity Broker Qualification Declaration Form expires 2022-04-30 and is listed under ICR 201902-1105-002.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
DocumentType
Form 1105-0080 Annuity Broker Qualification Declaration FormForm and Instruction
1105-0080 Supporting Statement_121515.docSupporting Statement A
Annuity Broker Qualification Declaration Form Form and Instruction

All Historical Document Collections

Historical document collections
ReferenceFilingReceivedConcludedAction
202204-1105-001 Extension without change of a currently approved collection 2022-04-20 Approved without change
201902-1105-002 Extension without change of a currently approved collection 2019-02-26 Approved without change
201512-1105-003 Extension without change of a currently approved collection 2016-01-13 Approved without change
201212-1105-001 Extension without change of a currently approved collection 2012-12-12 Approved without change
200905-1105-001 Revision of a currently approved collection 2009-11-02 Approved with change
200608-1105-001 Revision of a currently approved collection 2006-10-03 Approved without change
200309-1105-001 Extension without change of a currently approved collection 2003-09-25 Approved without change
200303-1105-001 New collection (Request for a new OMB Control Number) 2003-03-10 Approved without change