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U.S. Department of Health and Human Services

Potential Tobacco Product Violations Reporting - Form FDA 3779

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Form Approved: OMB NO. 0910-0716
Expiration Date: 07/31/2014

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Potential Violation Information

Error

Please correct all errors listed below:

 

mm/dd/yyyy

 

 

 

200 character limit

 

*Potential Violation Type

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*Type of Potentially Violative Promotional Materials

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1000 character limit

 

Allowed combined size of all the files is 8 MB.
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