Information Collection

Potential Tobacco Product Violations Reporting

IC 201526 under ICR 202301-0910-001 · OMB 0910-0716.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form FDA 3779 Potential Tobacco Product Violations Reporting	Form and Instruction
FDA 3779 Potential Tobacco Product Violations Report 0716_Form 3779_2023.pdf	Form and Instruction

IC Title:

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	Potential Tobacco Product Violations Report	0716_Form 3779_2023.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 3,000

Number of Respondents for Small Entity: 200

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 99 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	6,000	0	630	5,370
Annual IC Time Burden (Hours)	1,500	0	157	1,343
Annual IC Cost Burden (Dollars)	0	-24	0	24

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.