Information Collection

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

IC 237744 under ICR 202210-0910-002 · 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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
Document Name	Document Type
Form FDA 4057 PMTA submission; amendments; change in ownership; supplementals; resubmissions; reporting; AE reports; waivers	Form and Instruction
FDA 4057 Premarket Tobacco Product Application (PMTA) Submission FDA 4057.pdf	Form and Instruction
FDA 4057 Premarket Tobacco Product Application (PMTA) Submission FDA 4057.pdf	Form and Instruction
FDA 4057a Premarket Tobacco Product Application Amendment and Gene FDA 4057a.pdf	Form and Instruction
FDA 4057a Premarket Tobacco Product Application Amendment and Gene FDA 4057a.pdf	Form and Instruction
FDA 4057b Unique Identifying Information for New Tobacco Products FDA 4057b.xlsm	Form and Instruction
FDA 4057b Unique Identifying Information for New Tobacco Products FDA 4057b.xlsm	Form and Instruction

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 21 CFR 1114.15 21 CFR 1107.3

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	FDA 4057	Premarket Tobacco Product Application (PMTA) Submission	FDA 4057.pdf	Yes	Yes	Fillable Fileable Signable
Form and Instruction	FDA 4057a	Premarket Tobacco Product Application Amendment and General Correspondence Submission	FDA 4057a.pdf	Yes	Yes	Fillable Fileable Signable
Form and Instruction	FDA 4057b	Unique Identifying Information for New Tobacco Products	FDA 4057b.xlsm	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: 39

Number of Respondents for Small Entity: 10

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 99 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	191	74	117
Annual IC Time Burden (Hours)	13,740	0	13,740
Annual IC Cost Burden (Dollars)	0	0	0

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.