Form TTB F 5210.5 TTB F 5210.5 Report - Manufacturer of Tobacco Products or Cigarette P

OMB No. 1513-0033 (02/28/2014)

DEPARTMENT OF THE TREASURY

ALCOHOL AND TOBACCO TAX AND TRADE BUREAU (TTB)

REPORT – MANUFACTURER OF PROCESSED TOBACCO

GENERAL INSTRUCTIONS

A Who prepares this report? If you are a manufacturer of processed tobacco,
you must file this report. You must keep records and file reports as required in 27 CFR
40.521 and 40.522, including the requirement to file TTB F 5250.1 each month.
With certain exceptions described below, if you are a manufacturer of tobacco products
and you remove processed tobacco from the factory premises, you must file this report.
You do not need to file this report for: the removal of samples of processed tobacco for
the purpose of soliciting orders of tobacco products; the removal of processed tobacco
for destruction or for scientific testing or testing of equipment which results in the
destruction of the processed tobacco or the return of the processed tobacco to the
factory premises; the transfer of processed tobacco between your permitted premises;
and any removal of processed tobacco that you have shown to the satisfaction of the
appropriate TTB officer is connected with the business of a manufacturer of tobacco
products rather than with the business of a manufacturer of processed tobacco. Any
other removal of processed tobacco requires you to first obtain TTB approval to
conduct other business operations as provided in 27 CFR 40.47 and 40.72, and to

keep records and file reports as required in §§ 40.521 and 40.522, including the
requirement to file TTB F 5250.1 each month.

B. When must I prepare this report?
(1) The month in which you start your business as a manufacturer of processed
tobacco as noted above covered by your TTB permit or authorization.
(2) You must file each month whether or not you conduct any business as long as
you hold your TTB permit.
(3) When you discontinue the business covered by your TTB permit.
(4) When you transfer the business covered by your TTB permit to another person.
The other person to whom you transfer your business must have TTB approval before
commencing operations.
C. When must I file this report? File it no later than 20 days after the end of the
month that the report covers.
D. How do I file this form? Send this form to the TTB National Revenue Center,
550 Main St., Ste. 8002, Cincinnati, OH 45202-5215
Keep a copy for your records.

INSTRUCTIONS FOR ITEMS ON THE FORM
E. Item 1 - What is my employer identification number? The nine-digit code that
the Internal Revenue Service (IRS) has assigned to your business.
F. Item 2 - What is my TTB permit number? This "number" is listed on your TTB
permit to conduct operations as a Manufacturers of Processed Tobacco. For example,
MP-XX-1234, where XX is the 2-letter State abbreviation of the U.S. Post Office. Each
location at which you conduct operations has a "number." If you have more than one
TTB permit, file separate reports for each.
G. Item 3 - What time period(s) must my report cover?

H. Item 20 – Who may sign this report?
If your business is a
Sole Proprietorship

Time period(s):

Partnership

Starting business

From the day and month that you start business to the last
day of the same month

After starting
business

Each month

Corporation,
association, limited
liability company or
other business

Discontinuing or
From the first day of the month to the day of the same
transferring business month that you discontinue or transfer your business

TTB F 5250.1 (02/2013) 

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(1)
(2)

You; OR
An individual for whom you have filed an ATF or TTB F
5000.8, Power of Attorney, that grants authority to sign this report

Each partner; OR
The partner who has been given the authority to sign by the
articles of partnership or similar agreement of all the partners that
you filed for this permit; OR
(3) An individual for whom you filed an ATF or TTB F
5000.8, Power of Attorney, that grants Authority to sign this report
(1)
(2)

Report(s) for:

The report must be signed by:

(1)
(2)

An individual who has signature authority granted by the
business documents that you filed for this permit; OR
An individual for whom you filed an ATF or TTB F 5000.8, Power
of Attorney, that grants authority to sign this report

OMB No. 1513-0033 (02/28/2013)

DEPARTMENT OF THE TREASURY

ALCOHOL AND TOBACCO TAX AND TRADE BUREAU (TTB)

REPORT – MANUFACTURER OF PROCESSED TOBACCO
1.

My Employer Identification Number (Read instruction E)

2.

TTB Permit Number (Read instruction F)

4.

Is this your first or last report? (Check one box, only if it applies)

5.

Name and Premises Address:

3.

Report Covers Period of: (Read instruction G)

This report is my first report

This report is my last report and I have attached my permit OR

My permit is not attached because:
Processed Tobacco (Pounds) (Report your beginning and ending
inventory of processed tobacco on hand)

6. On Hand Start of Period

7. On Hand End of Period

Account for all processed tobacco received, manufactured, and transferred

ADDITIONS

8.

Processed Tobacco (Pounds)

Processed Tobacco Manufactured

9. Processed Tobacco Received:

a. From importers of processed tobacco

b. From other manufacturers of processed tobacco

c. rom manufacturers of tobacco products

10. Returns or Other Sources

11. Gains

REMOVALS

Account for all processed tobacco received, manufactured, and transferred

Processed Tobacco (Pounds)

12. Used in the manufacture of processed tobacco

13. Used in the manufacture of tobacco products
(entry only for those holding permit and bond to manufacture tobacco products)

14. Removed for transfer to other manufacturers of processed tobacco or importers of processed tobacco

15. Removed for transfer to manufacturers of tobacco products

16. Removed for sale or transfer to persons not holding TTB permit
(Any such sale or transfer of processed tobacco requires submission of TTB F 5250.2)

17. Exported or Transferred to Export Warehouse

18. Destroyed or removed for destruction

19. Losses

TTB F 5250.1 (02/2013) 

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OMB No. 1513-0033 (02/28/2013)

DEPARTMENT OF THE TREASURY

ALCOHOL AND TOBACCO TAX AND TRADE BUREAU (TTB)

REPORT – MANUFACTURER OF PROCESSED TOBACCO

UNDER PENALTIES OF PERJURY, I DECLARE THAT, TO THE BEST OF MY KNOWLEDGE AND BELIEF, THIS REPORT IS TRUE, ACCURATE, AND COMPLETE.

20. Signature (Read Instruction H)

21. Printed name of individual signing the form

22. Title of Person Signing

23. Date

24. E-Mail Address for Business

25. Business Telephone Number

PAPERWORK REDUCTION ACT NOTICE

This request is in accordance with the Paperwork Reduction Act of 1995. The purpose of this information collection is to monitor the operations of industries
regulated by TTB. TTB uses the information to monitor activities and determine errors or omissions on regulated commodities. The information requested is
mandatory by statute (26 U.S.C. 5712).

The estimated average burden associated with this collection is 1 hour per respondent or recordkeeper, depending on individual circumstances. Comments
concerning the accuracy of this burden estimate and suggestions for reducing this burden should be addressed to: Reports Management Officer, Regulations and
Rulings Division, Alcohol and Tobacco Tax and Trade Bureau, Washington, DC 20220.

An agency may not conduct or sponsor, and an individual is not required to respond to, a collection of information unless it displays a current, valid OMB control
number.

PRIVACY ACT INFORMATION

The following information complies with Section 3 of the Privacy Act of 1974 (5 U.S.C. 552a(e)(3)):
1. What is TTB’s authority to ask for this information? We require this information under the authority of 26 U.S.C. 5722. You must provide this information to
comply with law and regulations regarding transactions in a commodity regulated by TTB under a permit issued by TTB.
2. What is the purpose for this information collection? You must provide this information so that TTB will be able to determine whether your operations
conform with Federal laws and regulations.
3. How does TTB routinely use this information? We use this information to make determinations for the purposes described in paragraph 2. Also, if we are
not prohibited by law, we may disclose the information that you provided on this form to other Federal, State, foreign, or local law enforcement or regulatory agency
personnel, and to members of the public to verify it. Finally, we may disclose this information to the Justice Department if it appears that false information, which
constitutes a violation of Federal law, has been provided.
What is the effect if I do not supply the information TTB requests? If you fail to supply this information, then TTB may determine that you are not in
compliance with Federal laws and regulations and may initiate action to suspend or revoke your permit as provided for in 26 USC 5713.

TTB F 5250.1 (02/2013) 

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