Information Collection

FDA's Center for Tobacco Products State Department of Health Electronic Cigarette Adverse Event Survey

IC 201322 under ICR 201012-0910-003 · OMB 0910-0500.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0910-0500 can be found here:

Documents and Forms

Document Name Document Type
State Health Officer final 3pm.doc Other-Survey letter
FDA Rapid Response Survey Template CTP Adverse Events for Ecigs.doc OMB Justification Memo IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	FDA's Center for Tobacco Products State Department of Health Electronic Cigarette Adverse Event Survey	Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Survey letter			State Health Officer final 3pm.doc		No		Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 50	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	50	50
Annual IC Time Burden (Hours)	800	800
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
OMB Justification Memo	FDA Rapid Response Survey Template CTP Adverse Events for Ecigs.doc	02/27/2012

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.