Board of Governors of the Federal Reserve System OMB Number 7100-0100 Approval expires May 31, 2019
OMB Number 3064-0022 Approval expires March 31, 2018
Federal Deposit Insurance Corporation
OMB Number 1557-0184 Approval expires July 31, 2019
Offi ce of the Comptroller of the Currency
Page 1 of 3
Uniform Termination Notice for Municipal Securities Principal or
Municipal Securities Representative Associated with a
Bank Municipal Securities Dealer—Form MSD-5
An agency may not conduct or sponsor, and a person is not
The Board of Governors of the Federal Reserve System, the Federal
required to respond to, a collection of information unless it
Deposit Insurance Corporation, and the Offi ce of the Comptroller
displays a currently valid OMB control number. The information
of the Currency are authorized to collect this information pursuant
provided by each respondent is considered to be confi dential.
to the authority contained in the following statutes: 15 U.S.C. §§
78o-4, 78q, and 78w.
PRIVACY ACT NOTICE
The Federal Reserve Board is authorized to request this information from you by Sections 3, 15B(c), 15C, 17 and 23 of Securities Exchange Act of
1934 (15 U.S.C. 78c, 78o-4, 78o-5, and 78q and 78w); and Section 11 of the Federal Reserve Act (12 U.S.C. 248). The purpose for collecting the
information is to comply with the registration requirements of municipal securities dealers, municipal securities representatives, and U.S. Government
securities brokers or dealers and associated persons contained in the Securities Exchange Act of 1934, and to support the Board’s regulatory and
supervisory functions. Furnishing the requested information is mandatory. Failure to provide the requested information in whole or in part may delay
or prohibit the determination of your compliance with applicable registration and professional qualifi cation requirements. The information you provide
is protected by the Privacy Act, 5 U.S.C. 552(a). The information may be furnished to third parties as authorized by law and used according to any of
the routine uses described in the Municipal or Government Securities Principals and Representatives System of Records (BGFRS-17), available at
https:// If you have any questions or concerns about the collection
or use of the information, your may contact the Secretary of the Board, Board of Governors of the Federal Reserve System, 20th Street and
Constitution Avenue, NW, Washington, DC 20551.
Public reporting burden for this collection of information is estimated to average 15 minutes per response, including the time to gather and maintain data in the required form and to review
instructions and to complete the information collection. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing
this burden, to Offi ce of Management and Budget, Washington, DC 20503, and, depending on your primary federal regulator, to Secretary, Board of Governors of the Federal Reserve System,
20th and C Streets, NW, Washington, DC 20551; or to Assistant Executive Secretary, Federal Deposit Insurance Corporation, Washington, DC 20429; or to Legislative and Regulatory
Activities Division, Offi ce of the Comptroller of the Currency, Washington, DC 20219.
08/2016
1
2
3
4
5
6
