Potential Tobacco Product Violations Reporting

Potential Tobacco Product Violations Reporting Form

OMB: 0910-0716

IC ID: 201526

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Information Collection (IC) Details

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Potential Tobacco Product Violations Reporting
No Modified

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction FDA 3779 Potential Tobacco Product Violations Report Form FDA 3779.pdf Yes Yes Fillable Fileable

Health Consumer Health and Safety


2,685 200
Individuals or Households
   99 %

  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 5,370 0 0 3,870 0 1,500
Annual IC Time Burden (Hours) 1,343 0 0 968 0 375
Annual IC Cost Burden (Dollars) 24 0 0 17 0 7

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