Information Collection

Form 4 - Statement of Changes in Beneficial Ownership of Securities

IC 34761 under ICR 200711-3235-003 · OMB 3235-0287.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3235-0287 can be found here:

Documents and Forms

Document Name Document Type
Form SEC 1474 Form 4 - Statement of Changes in Beneficial Ownership of Securities Form
SEC 1474 Form 4 SEC 1474form4.pdf www.sec.gov/about/forms/form4.pdf Form
SEC 1475 Form 4 SEC 1475form4data.pdf www.sec.gov/about/forms/form4data.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Form 4 - Statement of Changes in Beneficial Ownership of Securities	Agency IC Tracking Number:	270-126

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 17 CFR 249.104

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SEC 1474	Form 4	SEC 1474form4.pdf	http://www.sec.gov/about/forms/form4.pdf	Yes	Yes	Fillable Fileable
Form	SEC 1475	Form 4	SEC 1475form4data.pdf	http://www.sec.gov/about/forms/form4data.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: 225,000	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	Previously Approved
Annual Number of Responses for this IC	225,000	225,000
Annual IC Time Burden (Hours)	112,500	112,500
Annual IC Cost Burden (Dollars)	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.