Information Collection

Potential Tobacco Product Violations Reporting

IC 201526 under ICR 202006-0910-006 · OMB 0910-0716.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0910-0716 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form FDA 3779 Potential Tobacco Product Violations Report Potential Tobacco Product Violations Reporting	Form and Instruction
FDA 3779 Potential Tobacco Product Violations Report Form FDA 3779.pdf	Form and Instruction

IC Title:

Potential Tobacco Product Violations Reporting

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

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 3779				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2,685

Number of Respondents for Small Entity: 200

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 99 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	5,370	3,870	1,500
Annual IC Time Burden (Hours)	1,343	968	375
Annual IC Cost Burden (Dollars)	24	17	7

Documents for IC

table that charts IC Documents
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.

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