Potential Tobacco Product Violations Reporting Form

ICR 201706-0910-019

OMB: 0910-0716

Federal Form Document

Forms and Documents
Form and Instruction
Supporting Statement A
IC Document Collections
ICR Details
0910-0716 201706-0910-019
Historical Active 201601-0910-007
Potential Tobacco Product Violations Reporting Form
Extension without change of a currently approved collection   No
Approved without change 07/25/2017
Retrieve Notice of Action (NOA) 06/23/2017
  Inventory as of this Action Requested Previously Approved
07/31/2020 36 Months From Approved 07/31/2017
1,500 0 800
375 0 200
7 0 4

This Information Collection Request (ICR) is for an extension of an existing approved collection. As part of its enforcement strategy, FDA created the Tobacco Call Center (with a toll-free number: 1-877-CTP-1373) to accept information from the public regarding potential violations of the Tobacco Control Act. Callers may report potential violations of the Tobacco Control Act, and FDA may conduct targeted followup investigations based on information received. When reporting a potential violation, callers will be asked to provide as much information about the violation as they can recall. The caller will also be asked to list the potential violator's Web site (if available), describe the potential violation, and provide any additional files or information pertinent to the potential violation. FDA currently provides a form that may be used to solicit this information from the caller (FDA Form 3779, Potential Tobacco Product Violations Reporting) and seeks renewal of Form 3779. This form is posted on FDA's Web site. The public and interested stakeholders will also be able to report information regarding possible violations of the Tobacco Control Act through the following methods: calling the Tobacco Call Center using CTP's toll-free number; using a fillable form found on FDA's Web site; downloading a PDF version of the form to send via email or mail to FDA; requesting a copy of FDA Form 3779 by contacting the Center for Tobacco Products and sending by mail to FDA; and sending a letter to FDA's Center for Tobacco Products. The public and interested stakeholders will also be able to report information regarding possible violations of the Tobacco Control Act in the future using FDA's tobacco violation reporting smartphone application.

PL: Pub.L. 111 - 111 31 Name of Law: Family Smoking Prevention and Tobacco Control Act

Not associated with rulemaking

  81 FR 78166 11/07/2016
82 FR 28492 06/22/2017

IC Title Form No. Form Name
Potential Tobacco Product Violations Reporting FDA 3779 Potential Tobacco Product Violations Report

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 1,500 800 0 0 700 0
Annual Time Burden (Hours) 375 200 0 0 175 0
Annual Cost Burden (Dollars) 7 4 0 0 3 0

Amber Sanford 301 796-8867 [email protected]


On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

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