Information Collection

Rule 204-3, Written Disclosure Statements

IC 34124 under ICR 202509-3235-003 · OMB 3235-0047.

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IC Title:	Rule 204-3, Written Disclosure Statements	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 17 CFR 275.204-3

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: 16,237	Number of Respondents for Small Entity: 483

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

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	16,237	16,237
Annual IC Time Burden (Hours)	62,525	62,525
Annual IC Cost Burden (Dollars)	0	0

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