Information Collection

Tobacco Health Document Submission

IC 191698 under ICR 201601-0910-020 · OMB 0910-0654.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0910-0654 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form FDA Tobacco Health Document Submission	Form and Instruction
FDA Tobacco Health Document Submission FDA-3743.pdf	Form and Instruction
TB Health Doc Submission Guidance.pdf Tobacco Health Document Submission Final Guidance	IC Document

IC Title:

Tobacco Health Document Submission

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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
Form and Instruction	FDA	Tobacco Health Document Submission	FDA-3743.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 10

Number of Respondents for Small Entity: 1

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 20 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	32	24	8
Annual IC Time Burden (Hours)	1,600	1,200	400
Annual IC Cost Burden (Dollars)	832	624	208

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Tobacco Health Document Submission Final Guidance	TB Health Doc Submission Guidance.pdf	08/06/2013

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