Smokeless Tobacco Nicotine and Ingredient Report

Annual Submission of the Ingredients Added to, and the Quantity of Nicotine Contained in, Smokeless Manufactured, Imported, or Packaged in the U.S.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0338 can be found here:

Documents and Forms

Document Name Document Type
Smokeless Tobacco Nicotine and Ingredient Report Form
Nicotine Reporting Format Attachment 4a-2 SLT Nicotine Report.doc Form
Ingredient Reporting Format Attachment 4a-1 SLT Ingredient Report.doc Form
Attachment 4b Reminder Notification Postcard.pdf Reminder Notice IC Document
Attachment 4c_Request for Add Information.doc Request for Additional Information IC Document
Attachment 6a OSH Tobacco Ingredient Reporting Web Page.pdf Ingredient Reporting Instructions IC Document
Attachment 6b OSH Tobacco Ingredient Reporting Web Page.pdf OSH Web Page IC Document

Information Collection (IC) Details

IC Title:	Smokeless Tobacco Nicotine and Ingredient Report	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 18 CFR 1905 15 CFR 4401

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	none	Nicotine Reporting Format	Attachment 4a-2 SLT Nicotine Report.doc		No	No	Paper Only
Form	none	Ingredient Reporting Format	Attachment 4a-1 SLT Ingredient Report.doc		No	No	Paper Only

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 13	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	13	13
Annual IC Time Burden (Hours)	22,269	22,269
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Reminder Notice	Attachment 4b Reminder Notification Postcard.pdf	01/27/2014
Request for Additional Information	Attachment 4c_Request for Add Information.doc	01/27/2014
Ingredient Reporting Instructions	Attachment 6a OSH Tobacco Ingredient Reporting Web Page.pdf	01/27/2014
OSH Web Page	Attachment 6b OSH Tobacco Ingredient Reporting Web Page.pdf	01/27/2014

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