Ingredient Report

List of Ingredients Added to Tobacco in the Manufacture of Cigarette Products

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0210 can be found here:

Documents and Forms

Document Name Document Type
Attachment 4a Ingredient Report.pdf Other-WORD
Attachment 8. Request for Add Info.doc Attachment 8 - Request for Additional Information IC Document
Attachment 4b Reminder Notification.pdf Attachment 4b Reminder Notification IC Document
Attachment 4c Request for Additional Information.pdf Attachment 4c Request for Additional Information IC Document

Information Collection (IC) Details

IC Title:	Ingredient Report	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			Attachment 4a Ingredient Report.pdf		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 77	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	77	77
Annual IC Time Burden (Hours)	501	501
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Attachment 8 - Request for Additional Information	Attachment 8. Request for Add Info.doc	12/12/2007
Attachment 4b Reminder Notification	Attachment 4b Reminder Notification.pdf	12/28/2012
Attachment 4c Request for Additional Information	Attachment 4c Request for Additional Information.pdf	12/28/2012

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