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⚠️ Notice: This information collection may be referencing outdated material.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
Ingredient Report Form
Ingredient Report Attachment 4a - Ingredient Report.doc Form
Attachment 4b Reminder Notification.pdf Att 4b - Reminder notification IC Document
Attachment 4c Request for Additional Information.docx Att 4c - Request for Additional Information 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:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	none	Ingredient Report	Attachment 4a - Ingredient Report.doc		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 77	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	77	-66	143
Annual IC Time Burden (Hours)	501	-429	930
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Att 4b - Reminder notification	Attachment 4b Reminder Notification.pdf	06/14/2012
Att 4c - Request for Additional Information	Attachment 4c Request for Additional Information.docx	06/14/2012

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