Information Collection

General identifying information provided by manufacturers and importers of FDA regulated tobacco products and Identification and removal information (monthly); Form FDA 3852

IC 207250 under ICR 201605-0910-003 · 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⚠️ Notice: This information collection may be referencing outdated material.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

Document Name Document Type
Form FDA 3852 General identifying information provided by manufacturers and importers of FDA regulated tobacco products and Identification and removal information (monthly); Form FDA 3852 Form and Instruction
FDA 3852 Report of Tobacco Product Removals Subject to Tax FDA-3852.pdf Form and Instruction
Section_1150_5_a_b1_b2_FDA3852.doc Section_1150_5_a_b1_b2_FDA3852 IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	General identifying information provided by manufacturers and importers of FDA regulated tobacco products and Identification and removal information (monthly); Form FDA 3852	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

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

Information Collection 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	FDA-3852.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 335	Number of Respondents for Small Entity: 180

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

Percentage of Respondents Reporting Electronically: 90 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	4,020	1,620	2,400
Annual IC Time Burden (Hours)	12,060	4,860	7,200
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Section_1150_5_a_b1_b2_FDA3852	Section_1150_5_a_b1_b2_FDA3852.doc	03/08/2014

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