Information Collection Request

Form 5 - Annual Statement of Beneficial Ownership

ICR 202301-3235-011 · OMB 3235-0362 · Received in OIRA

⚠️ Notice: This information collection may be outdated. More recent filings for OMB 3235-0362 can be found here:

Forms and Documents

Document Name	Status
Form SEC 2270 Form 5 - Annual Statement of Beneficial Ownership Form	Modified
Rule10b5-1 Supporting Statement.Final.pdf Supporting Statement A	2023-01-10
February 5, 2020 EDGAR PIA.pdf Supplementary Document	2023-01-10

IC Document Collections

IC ID	Document Title	Status
34921	Form 5 - Annual Statement of Beneficial Ownership Form	Modified

ICR Details

Status	Received in OIRA
Agency/Subagency	SEC
OMB Control No	3235-0362
Type of Information Collection	Revision of a currently approved collection
Previous ICR Reference No	202006-3235-008
Agency Tracking No	CF 270-323
Date Submitted to OIRA	1969-12-31
Requested Expiration Date	1969-12-31