OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Suspicious Activity Report by Insurance Companies

ICR 201412-1506-002 · OMB 1506-0029 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Form FinCEN 111 Bank Secrecy Act Suspicious Activity Report Form and Instruction Modified Available
2014 Reports by Insurance Companies of suspicious transactions SUPPORTING STATEMENT.doc Supporting Statement A Uploaded 2014-12-15 Available
IC Document Collections
IC IDCollectionTypeStatusForm
15337 Bank Secrecy Act Suspicious Activity Report Form and Instruction Modified
ICR Details
1506-0029 201412-1506-002
Historical Active 201109-1506-004
TREAS/FINCEN
Suspicious Activity Report by Insurance Companies
Extension without change of a currently approved collection   No
Regular
Approved without change 04/08/2015
Retrieve Notice of Action (NOA) 12/30/2014
Upon renewal, agency will include a PRA and Privacy Statement on the instrument, whether paper or electronic.
  Inventory as of this Action Requested Previously Approved
04/30/2018 36 Months From Approved 04/30/2015
1 0 1
1 0 1
0 0 0
31 CFR 1025.320 requires insurance companies to report suspicious activities to the Financial Crimes Enforcement Network. FinCEN Form 111 is an aid to this required reporting providing the filer with a guide in completing this reporting requirement. The form is used by criminal investigators, and taxation and regulatory enforcement authorities, during the course of investigations involving financial crimes. This action renews the regulation only.
US Code: 31 USC 5311-5330 Name of Law: Bank Secrecy Act
  
None
Not associated with rulemaking
  79 FR 56123 09/18/2014
79 FR 77083 12/23/2014
No
1
IC Title Form No. Form Name
Bank Secrecy Act Suspicious Activity Report FinCEN 111 Suspicious Activity Report
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 1 1 0 0 0 0
Annual Time Burden (Hours) 1 1 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
$0
No
No
No
No
No
Uncollected
Russell Stephenson 202 354-6012
  No
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
12/30/2014