Form Approved
OMB No. 0920-0210
Exp. xx/xx/20xx
Recommended Cigarette Ingredient Reporting Format - FCLAA
Please attach additional pages if necessary
Date
Office on Smoking and Health
Attn. FCLAA Program Manager
4770 Buford Hwy., NE, MS S107-7
Atlanta, GA 30341-3717
This ingredient report is being submitted pursuant to the Federal Cigarette Labeling and Advertising Act (FCLAA), 15 U. S.C. §1335a(a).
Company Name(s)*
Brand(s)†
*If this Ingredient Report is submitted by a designated individual or entity on behalf of a cigarette manufacturer, packager, or importer, the form must specify on whose behalf the submission is being made.
†Inclusion of the brand name and product type for ingredients is not required under FCLAA.
Ingredient Name ¶ CAS Registry Number§
¶
Public reporting burden of
this collection of information is estimated to average 6.5 hours
per response, including the time for reviewing instructions,
searching existing data sources, gathering and maintaining the data
needed, and completing and reviewing the collection of information.
An agency may not conduct or sponsor, and a person is not required
to respond to a collection of information unless it displays a
currently valid OMB control number. Send comments regarding this
burden estimate or any other aspect of this collection of
information, including suggestions for reducing this burden to CDC
Reports Clearance Officer, 1600 Clifton Road, MS-74, Atlanta, GA
30333, ATTN: PRA (0920-0210).
| File Type | application/msword |
| Author | Ruth L Hayes |
| Last Modified By | SYSTEM |
| File Modified | 2019-04-09 |
| File Created | 2019-04-09 |