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Tobacco Product Ingredient Listing electronic and paper submission (vape shops that qualify as manufacturers)
Tobacco Product Establishment Registration and Submission of Certain Health Information
OMB: 0910-0650
IC ID: 221396
OMB.report
HHS/FDA
OMB 0910-0650
ICR 201712-0910-004
IC 221396
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0910-0650 can be found here:
2023-03-24 - No material or nonsubstantive change to a currently approved collection
2022-08-12 - Extension without change of a currently approved collection
Documents and Forms
Document Name
Document Type
Form FDA 3742
Tobacco Product Ingredient Listing electronic and paper submission (vape shops that qualify as manufacturers)
Form and Instruction
Copy of Ingredients Form_List_of_Values.xls
Other-null
Ingredients Screenshots_clean.doc
Other-screenshots
FDA 3742 Listing of Ingredients in Tobacco Products
FDA-3742 5-5-2016.pdf
Form and Instruction
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Tobacco Product Ingredient Listing electronic and paper submission (vape shops that qualify as manufacturers)
Agency IC Tracking Number:
CTP
Is this a Common Form?
No
IC Status:
Unchanged
Obligation to Respond:
Mandatory
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form and Instruction
FDA 3742
Listing of Ingredients in Tobacco Products
FDA-3742 5-5-2016.pdf
Yes
Yes
Fillable Fileable
Other-null
Copy of Ingredients Form_List_of_Values.xls
Yes
No
Paper Only
Other-screenshots
Ingredients Screenshots_clean.doc
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Consumer Health and Safety
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
4,250
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
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
49,853
0
0
0
0
49,853
Annual IC Time Burden (Hours)
49,853
0
0
0
0
49,853
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
No associated records found
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.