Information Collection

PMTA submission; amendments; change in ownership; supplementals; resubmissions; reporting; AE reports; waivers

IC 237744 under ICR 202204-0910-012 · OMB 0910-0879.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0910-0879 can be found here:

Documents and Forms

Document Name Document Type
Form Form FDA 4057 PMTA submission; amendments; change in ownership; supplementals; resubmissions; reporting; AE reports; waivers Form and Instruction
Form FDA 4057 Premarket Tobacco Product Application (PMTA) Submission FDA-4057 Final.pdf Form and Instruction
Form FDA 4057 Premarket Tobacco Product Application (PMTA) Submission FDA-4057 Final.pdf Form and Instruction
Form FDA 4057a Premarket Tobacco Product Application Amendment and Gene FDA-4057a Final.pdf Form and Instruction
Form FDA 4057a Premarket Tobacco Product Application Amendment and Gene FDA-4057a Final.pdf Form and Instruction
Form FDA 4057b Unique Identifying Information for New Tobacco Products Product Grouping_4057b 1.2021.xlsm Form and Instruction
Form FDA 4057b Unique Identifying Information for New Tobacco Products Product Grouping_4057b 1.2021.xlsm Form and Instruction
FDA 4057b Premarket Tobacco Product Application Grouping Submissio FDA Form 4057b 3.31.22.xlsm Form and Instruction
FDA 4057b Premarket Tobacco Product Application Grouping Submissio FDA Form 4057b 3.31.22.xlsm Form and Instruction
FDA 4057b Premarket Tobacco Product Application Grouping Submissio 4057b Detailed 3.31.22.xlsx Form and Instruction
FDA 4057b Premarket Tobacco Product Application Grouping Submissio 4057b Detailed 3.31.22.xlsx Form and Instruction
Request for Emergency Clearance (Signed).pdf Emergency request memo to modify form FDA 4057b IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	PMTA submission; amendments; change in ownership; supplementals; resubmissions; reporting; AE reports; waivers	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 21 CFR 1100.204 21 CFR 1107.3 21 CFR 1114.5 21 CFR 1114.9 21 CFR 1114.13 21 CFR 1114.17 21 CFR 1114.41 21 CFR 1114.45 21 CFR 1114.49

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	Form FDA 4057	Premarket Tobacco Product Application (PMTA) Submission	FDA-4057 Final.pdf	Yes	Yes	Fillable Fileable Signable
Form and Instruction	Form FDA 4057a	Premarket Tobacco Product Application Amendment and General Correspondence Submission	FDA-4057a Final.pdf	Yes	Yes	Fillable Fileable Signable
Form and Instruction	Form FDA 4057b	Unique Identifying Information for New Tobacco Products	Product Grouping_4057b 1.2021.xlsm	Yes	Yes	Fillable Fileable
Form and Instruction	FDA 4057b	Premarket Tobacco Product Application Grouping Submission	FDA Form 4057b 3.31.22.xlsm	Yes	Yes	Fillable Fileable
Form and Instruction	FDA 4057b	Premarket Tobacco Product Application Grouping Submission (detailed changes)	4057b Detailed 3.31.22.xlsx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 24	Number of Respondents for Small Entity: 10

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 99 %

	Approved	Program Change Due to New Statute	Previously Approved
Annual Number of Responses for this IC	117	45	72
Annual IC Time Burden (Hours)	13,740	148	13,592
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Emergency request memo to modify form FDA 4057b	Request for Emergency Clearance (Signed).pdf	04/13/2022

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.