Information Collection

Draft FDA 3852 Report of Tobacco Product Removals Subject to Tax

IC 207250 under ICR 201306-0910-002 · OMB 0910-0749.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0910-0749 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form FDA 3852 Draft FDA 3852 Report of Tobacco Product Removals Subject to Tax	Form and Instruction
FDA 3852 Report of Tobacco Product Removals Subject to Tax Draft_FDA_3852.pdf	Form and Instruction
Section 1150_5_a_b1_b2_FDA3852.doc Section 1150_5_a_b1_b2_FDA3852	IC Document

IC Title:

Draft FDA 3852 Report of Tobacco Product Removals Subject to Tax

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Mandatory

CFR Citation: 21 CFR 1150.5(b)(1) 21 CFR 1150.5(a) 21 CFR 1150.5(b)(2)

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
Form and Instruction	FDA 3852	Report of Tobacco Product Removals Subject to Tax	Draft_FDA_3852.pdf		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 200

Number of Respondents for Small Entity: 180

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 90 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	2,400	2,400
Annual IC Time Burden (Hours)	7,200	7,200
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Section 1150_5_a_b1_b2_FDA3852	Section 1150_5_a_b1_b2_FDA3852.doc	06/05/2013

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