Information Collection

Rule 17a-5(e)(4): Annual General Assessment Reconciliation or Exclusion from Membership Form

IC 222280 under ICR 201606-3235-015 · OMB 3235-0123.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3235-0123 can be found here:

Documents and Forms

Document Name Document Type

No indexed documents/forms are available for this IC yet. A refresh has been queued.

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Rule 17a-5(e)(4): Annual General Assessment Reconciliation or Exclusion from Membership Form	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Mandatory

CFR Citation: 17 CFR 240.17a-5

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: 4,393	Number of Respondents for Small Entity: 1,524

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

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Program Change Due to New Statute
Annual Number of Responses for this IC	4,393	4,393
Annual IC Time Burden (Hours)	21,965	21,965
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.