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Form for Submitting a Report in Accordance with Treasury’s Large Position Reporting Rules (17 CFR part 420)

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CONFIDENTIALITY - The Government Securities Act (GSA) specifically provides that Treasury shall not be compelled to disclose publicly any information required to be kept or reported for large position reporting. In particular, the GSA exempts such information from disclosure under the Freedom of Information Act (15 U.S.C. 78o-5(f)(6)).

View the supplementary formula guidance for preparing and submitting a report in accordance with Treasury's large position reporting rules.

Questions regarding Treasury's large position reporting rules or the method of submission of the reports should be directed to Treasury's Government Securities Regulations Staff (GSRS) at (202) 504 - 3632 or govsecreg@fiscal.treasury.gov. If you are unable to submit a large position report via the webform, you may fax the report to GSRS at (202) 504 - 3788. Please call GSRS prior to faxing reports.

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Administrative Information to be Provided in the Report

Fields marked with an asterisk(*) are required.

















Formula for Determining Whether to Submit a Large Position Report

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(use the scroll bar on the right to see the entire table)

  Security Description CUSIP Number Report Date Reports Due by
  Column A Column B
Part I. Positions in the Security Being Reported as of the Opening of Business on the Report Date Quantity  
$
 
$
 
$
 
$
 
$
 
Part II. Settlement Obligations Attributable to Outright Purchase and Sale Contracts Negotiated Prior to or on the Report Date (excluding settlement fails) Obligations to Receive Obligations to Deliver
$
$
$
$
$
$
$
$
$
Part III. Settlement Obligations Attributable to Delivery-versus-Payment Financing Contracts (including repurchase agreements and securities lending agreements) Negotiated Prior to or on the Report Date (excluding settlement fails)

Obligations to Receive Obligations to Deliver
$
$
$
$
$
$
Part IV. Settlement Fails from Days Prior to the Report Date (Legacy Obligations) Obligations to Receive Obligations to Deliver
$
$
Part V. Settlement Fails as of the Close of Business on the Report Date Obligations to Receive Obligations to Deliver
$
$
Part VI. Positions in the Security Being Reported as of the Close of Business on the Report Date Quantity  
$
 
$
 
$
 
$
 
$
 
Part VII. Quantity of Continuing Delivery-versus-Payment Financing Contracts for the Security Being Reported Quantity Borrowed Quantity Lent
$
$
Part VIII. Futures and Options Contracts Quantity if Net Long Quantity if Net Short



$
$

$
$

When you click "Review" below, the review page will display which criteria triggered the reporting requirement. A reporting entity must check the box for criterion G if it meets the reporting requirement. From the review page you will also be able to print a copy of the report for your records.

Optional - Identify the business(es) engaged in by the reporting entity and any of its aggregating entities with respect to the specified Treasury security (check all that apply).




Statement of Certification: "By signing below, I certify that the information contained in this report with regard to the designated filing entity is accurate and complete. Further, after reasonable inquiry and to the best of my knowledge and belief, I certify that: (i) the information contained in this report with regard to any other aggregating entities is accurate and complete; and (ii) the reporting entity, including all aggregating entities, is in compliance with the requirements of 17 CFR Part 420."


Note: By typing a name in this field, the signatory acknowledges and represents that the entry constitutes in every way, use, or aspect, his or her legally binding signature.