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)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3235-0037 can be found here:

Documents and Forms

Document Name Document Type
Form SEC 1666 Form X-17F-1A Form and Instruction
SEC 1666 Form X-17F-1A formx-17f-1a.pdf www.sec.gov/about/forms/formx-17f-1a.pdf Form and Instruction

Information Collection (IC) Details

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 249.100 17 CFR 240.17f-1(c)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	SEC 1666	Form X-17F-1A	formx-17f-1a.pdf	http://www.sec.gov/about/forms/formx-17f-1a.pdf	No		Paper Only

Line of Business: Economic Development

Subfunction: Financial Sector Oversight

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 10,100	Number of Respondents for Small Entity: 9,800

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

Percentage of Respondents Reporting Electronically: 90 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	303,000	-162,000	465,000
Annual IC Time Burden (Hours)	25,250	-13,500	38,750
Annual IC Cost Burden (Dollars)	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.