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Form X-17F-1A
Reporting of missing, lost, stolen or counterfeit securities (17 CFR Section 240.17f-1(c); Form X-17F-1A (17 CFR Section 249.100)
OMB: 3235-0037
IC ID: 34104
OMB.report
SEC
OMB 3235-0037
ICR 201208-3235-011
IC 34104
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3235-0037 can be found here:
2022-01-11 - Extension without change of a currently approved collection
2018-12-12 - Extension without change of a currently approved collection
Documents and Forms
Document Name
Document Type
Form Form X-17F-1A
Form X-17F-1A
Form and Instruction
Form X-17F-1A Reporting of missing, lost, stolen or counterfeit securi
formx-17f-1a.pdf
www.sec.gov/about/forms/formx-17f-1a.pdf
Form and Instruction
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Form X-17F-1A
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Modified
Obligation to Respond:
Mandatory
CFR Citation:
17 CFR 240.17f-1(c)
17 CFR 249.100
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form and Instruction
Form X-17F-1A
Reporting of missing, lost, stolen or counterfeit securities (
formx-17f-1a.pdf
http://www.sec.gov/about/forms/formx-17f-1a.pdf
No
Paper Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
Economic Development
Subfunction:
Financial Sector Oversight
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
26,000
Number of Respondents for Small Entity:
17,000
Affected Public:
Private Sector
Private Sector:
Businesses or other for-profits
Percentage of Respondents Reporting Electronically:
90 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
1,300,000
0
0
0
0
1,300,000
Annual IC Time Burden (Hours)
108,333
0
0
0
0
108,333
Annual IC Cost Burden (Dollars)
0
0
0
0
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.