List of Ingredients Added in the Manufacture of Smokeless Tobacco Products

Annual Submission of the Ingredients Added to, and the Quantity of Nicotine Contained in, Smokeless Manufactured, Imported, or Packaged in the U.S.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0338 can be found here:

Documents and Forms

Document Name Document Type
Att 4a-1 SLT Ingredient Report.doc Other-WORD
Att 4a-2 SLT Nicotine Report.doc Other-WORD
Att 4b Reminder Notification.pdf Att 4b Reminder Notification IC Document
Att 4c Reminder Notification.doc Att 4c Reminder Notification IC Document
Att 6a Web Page_OSH Tob Ingred Rep.pdf Att 6a Web Page_OSH Tob Ingred Rep IC Document
Att 6b Web Page_OSH Comp Smokeless Tob Hlth Edu Act.pdf Att 6b Web Page_OSH Comp Smokeless Tob Hlth Edu Act IC Document

Information Collection (IC) Details

IC Title:	List of Ingredients Added in the Manufacture of Smokeless Tobacco Products	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 18 CFR 1905 15 CFR 4401

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-WORD			Att 4a-1 SLT Ingredient Report.doc		Yes	Yes	Fillable Printable
Other-WORD			Att 4a-2 SLT Nicotine Report.doc		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 13	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	13	2	11
Annual IC Time Burden (Hours)	22,269	3,426	18,843
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Att 4b Reminder Notification	Att 4b Reminder Notification.pdf	06/29/2012
Att 4c Reminder Notification	Att 4c Reminder Notification.doc	06/29/2012
Att 6a Web Page_OSH Tob Ingred Rep	Att 6a Web Page_OSH Tob Ingred Rep.pdf	06/29/2012
Att 6b Web Page_OSH Comp Smokeless Tob Hlth Edu Act	Att 6b Web Page_OSH Comp Smokeless Tob Hlth Edu Act.pdf	06/29/2012

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