Information Collection

Schedule 13D and Schedule 13G Reporting - Acquisition Statement

IC 205020 under ICR 201602-1557-004 · OMB 1557-0106.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1557-0106 can be found here:

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IC Title:	Schedule 13D and Schedule 13G Reporting - Acquisition Statement	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 12 CFR 194 12 CFR 11

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Line of Business: Economic Development

Subfunction: Financial Sector Oversight

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	1	-3	4
Annual IC Time Burden (Hours)	2	-6	8
Annual IC Cost Burden (Dollars)	0	0	0

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