Comprehensive Iran Sanctions, Accountability, and Divestment Act of 2010 (Model Certification)

Reporting Obligations on Foreign Bank Relationships with Iranian-Linked Financial Institutions Designated under IEEPA and IRGC-Linked Persons Designated under IEEPA (31 CFR 1060.300)

Documents and Forms

Document Name Document Type
Form CISADA Model Form Comprehensive Iran Sanctions, Accountability, and Divestment Act of 2010 (Model Certification) Form
CISADA Model Form Certification CISADA 2018 Certification.docx www.fincen.gov/sites/default/files/federal_register_notice/CISADA_Certification.pdf Form
CISADA Model Form Certification CISADA 2018 Certification.docx www.fincen.gov/sites/default/files/federal_register_notice/CISADA_Certification.pdf Form

Information Collection (IC) Details

IC Title:	Comprehensive Iran Sanctions, Accountability, and Divestment Act of 2010 (Model Certification)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 31 CFR 1060.300

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	CISADA Model Form	Certification	CISADA 2018 Certification.docx	https://www.fincen.gov/sites/default/files/federal_register_notice/CISADA_Certification.pdf	Yes	Yes	Paper Only

Line of Business: Law Enforcement

Subfunction: Criminal Investigation and Surveillance

Privacy Act System of Records
Title: FinCEN's System of Records Notice for the BSA System	FR Citation: 79 FR 20974

Number of Respondents: 520	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	520	-380	900
Annual IC Time Burden (Hours)	1,560	-1,140	2,700
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.