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⚠️ Notice: This information collection may be referencing outdated material.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
Ingredient Report Form
Ingredient Report Attachment 4a Ingredient Report.doc Form
Attachment 4b Reminder Notification Postcard.pdf Reminder Postcard IC Document
Attachment 4c Request for Additional Information.pdf Request for Additional Information IC Document
Attachment 6 Certificate of Compliance.pdf Certificate of Compliance 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
Form	none	Ingredient Report	Attachment 4a Ingredient Report.doc		Yes	No	Printable Only

Line of Business: Health

Subfunction: Immunization Management

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	Previously Approved
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
Reminder Postcard	Attachment 4b Reminder Notification Postcard.pdf	01/23/2014
Request for Additional Information	Attachment 4c Request for Additional Information.pdf	01/23/2014
Certificate of Compliance	Attachment 6 Certificate of Compliance.pdf	01/23/2014

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