Information Collection

Dissolvable Tobacco Products Information Request

IC 196906 under ICR 201103-0910-002 · OMB 0910-0685.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Dissolvable 904(b) Request Letter-022511.doc	Instruction
Dissolvables 30-day draft.doc Dissolvable Letter Request 30 Day Federal Register Notice	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			Dissolvable 904(b) Request Letter-022511.doc		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 120

Number of Respondents for Small Entity: 113

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 80 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	120	120
Annual IC Time Burden (Hours)	24,220	24,220
Annual IC Cost Burden (Dollars)	924	924

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Dissolvable Letter Request 30 Day Federal Register Notice	Dissolvables 30-day draft.doc	02/25/2011

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