Ingredient Report

List of Ingredients Added to Tobacco in the Manufacture of Cigarette Products

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0210 can be found here:

Documents and Forms

Document Name Document Type
Form no number Ingredient Report Form and Instruction
no number Tobacco Ingredient Reporting Web Page Tobacco Ingredient Reporting Webpage.pdf Form and Instruction
1 Recommended Ingredient Reporting Format-CSTHEA Attachment 4a Ingredient Report.doc Form and Instruction
Attachment 3. Reminder Postcard.doc Attachment 3 - reminder postcard IC Document
Attachment 4b. OSH Web Page on Act.pdf Attachment 4b - OSH web page IC Document
Attachment 8. Request for Add Info.doc Attachment 8 - Request for Additional Information IC Document
Attachment 5b OSH Web Page on Tobacco Ingredient Reporting.pdf Attachment 5b OSH Web Page on Tobacco Ingredient Reporting IC Document
Attacthment 7a Guidelines to Control & Protect Documents that contain Privileged info.pdf Attacthment 7a Guidelines to Control & Protect Documents that contain Privileged info IC Document

Information Collection (IC) Details

IC Title:	Ingredient Report	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 15 CFR 4401 18 CFR 1905

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	no number	Tobacco Ingredient Reporting Web Page	Tobacco Ingredient Reporting Webpage.pdf		No	No	Paper Only
Form and Instruction	1	Recommended Ingredient Reporting Format-CSTHEA	Attachment 4a Ingredient Report.doc		No	No	Paper Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 143	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	143	143
Annual IC Time Burden (Hours)	930	930
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Attachment 3 - reminder postcard	Attachment 3. Reminder Postcard.doc	12/12/2007
Attachment 4b - OSH web page	Attachment 4b. OSH Web Page on Act.pdf	12/12/2007
Attachment 8 - Request for Additional Information	Attachment 8. Request for Add Info.doc	12/12/2007
Attachment 5b OSH Web Page on Tobacco Ingredient Reporting	Attachment 5b OSH Web Page on Tobacco Ingredient Reporting.pdf	01/20/2011
Attacthment 7a Guidelines to Control & Protect Documents that contain Privileged info	Attacthment 7a Guidelines to Control & Protect Documents that contain Privileged info.pdf	01/20/2011

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