Information Collection

Form 4 - Statement of Changes in Beneficial Ownership of Securities

IC 34761 under ICR 201409-3235-022 · 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⚠️ Notice: This information collection may be referencing outdated material.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
form4datainstructions.12-31-2014.pdf www.sec.gov/about/forms/form4data.pdf Instruction
SEC 1474 Form 4 - Statement of Changes In Beneficial Ownership form4.12-31-2014.pdf www.sec.gov/about/forms/form4.pdf Form
secsorn5.pdf SEC SORN 5 IC Document
EDGAR PIA_Redacted.pdf EDGAR PIA REDACTED IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Form 4 - Statement of Changes in Beneficial Ownership of Securities	Agency IC Tracking Number:	CF 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 - Statement of Changes In Beneficial Ownership	form4.12-31-2014.pdf	http://www.sec.gov/about/forms/form4.pdf	Yes	Yes	Fillable Fileable
Instruction			form4datainstructions.12-31-2014.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: (SEC 5) Ownership Reports and Insider Trading Transaction Records File under the Securities Exchange Act of 1934, Public Utility Holding Company Act of 1935, and Investment Company Act of 1940 --SEC	FR Citation: 41 FR 41550

Number of Respondents: 204,054	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	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	204,054	9,154	194,900
Annual IC Time Burden (Hours)	102,027	4,577	97,450
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
SEC SORN 5	secsorn5.pdf	12/17/2014
EDGAR PIA REDACTED	EDGAR PIA_Redacted.pdf	12/17/2014

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.