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Disclosure Form for Person Associated with a Financial Institution Securities Broker or Dealer
Notices Required of Government Securities Dealers or Brokers (Insured State Nonmember Banks)
OMB: 3064-0093
IC ID: 235136
OMB.report
FDIC
OMB 3064-0093
ICR 201902-3064-008
IC 235136
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3064-0093 can be found here:
2023-06-08 - No material or nonsubstantive change to a currently approved collection
2022-02-17 - Extension without change of a currently approved collection
Documents and Forms
Document Name
Document Type
Form G-FIN-4
Disclosure Form for Person Associated with a Financial Institution Securities Broker or Dealer
Form and Instruction
G-FIN-4 Disclosure Form for Person Associated with a Financial I
G-FIN-4.pdf
Form and Instruction
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Disclosure Form for Person Associated with a Financial Institution Securities Broker or Dealer
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
New
Obligation to Respond:
Mandatory
CFR Citation:
17 CFR Part 401 (To search for a specific CFR, visit the
Code of Federal Regulations.
)
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form and Instruction
G-FIN-4
Disclosure Form for Person Associated with a Financial Institution Securities Broker or Dealer
G-FIN-4.pdf
Yes
No
Fillable Printable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Economic Development
Subfunction:
Financial Sector Oversight
Privacy Act System of Records
Title:
Professional Qualification Records for Municipal Securities Dealers, Municipal Securities Representatives and U.S. Government Securities Broker/Dealers
FR Citation:
80 FR 66982
Number of Respondents:
1
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
0 %
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
0
0
1
0
0
Annual IC Time Burden (Hours)
2
0
0
2
0
0
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.