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Idaho NPM Initial Response - Idaho
| Idaho NPM Initial Response Form. This is a Idaho form and can be used in Consumer Protection Division Office Of Attorney General Statewide . |
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OFFICE OF THE ATTORNEY GENERAL Lawrence G. Wasden Consumer Protection Division 954 W. Jefferson, 2nd Floor P.O. Box 83720 Boise, ID 83720-0010 Phone: (208) 334-2424 Idaho Non-Participating Manufacturer Initial Response ________________________________________________________________________ Part 1: Date of Submission _________________ ________________________________________________________________________ Part 2: Non-Participating Manufacturer (hereafter NPM Applicant) Identification NPM Applicant's Name: __________________________________________________________ Concurrent with the submission of this form, the NPM Applicant has submitted its Idaho NonYes No Participating Manufacturer Certificate of Compliance. Name of Person Completing Initial Response Form: ___________________________________ Title of Person Completing Initial Response Form: ____________________________________ ________________________________________________________________________ Part 3: Information Request A. All NPM Applicants Provide the information requested. On separate sheets of paper, respond to each question or indicate N/A. All attachments must indicate the request number to which it corresponds. 1. A complete list of Cigarettes that the NPM Applicant manufactures, no matter where sold; time periods for manufacture of those Brand Families and the place of manufacture of those Brand Families. A complete list of other tobacco products (e.g. cigars, pipe tobacco, smokeless tobacco, etc.) that the NPM Applicant manufactures, no matter where sold; time periods for manufacture of those Brand Families; and the place of manufacture of those Brand Families. A list of prior manufacturers, if any, of each of the Brand Families listed in Part 3 of the Idaho Non-Participating Manufacturer Certificate of Compliance form. 2. 3. IDAHO NON-PARTICIPATING MANUFACTURER INITIAL RESPONSE1 of 3 (revised 3/7/2008) American LegalNet, Inc. www.FormsWorkFlow.com 4. For each Brand Family listed in Part 3 of the Idaho Non-Participating Manufacturer Certificate of Compliance form, provide the following: a. The date manufacturing first commenced or is intended to commence. b. Explanation of the manufacturing process that constitutes fabrication of the listed Brand Families. c. The name, physical address, and factory contact where the Brand Families are or will be manufactured. 5. If the NPM Applicant previously imported or distributed Cigarettes in the U.S., list each Brand Family name and the manufacturer's name and address for each Brand Family. If the NPM Applicant delivers or plans to deliver Cigarettes directly to an Idaho Stamping Agent, list all such Stamping Agents. If the NPM Applicant does not sell directly to Idaho Stamping Agents, provide a list of all importers and/or distributors to which Cigarettes were or will be sold during the sales year indicated. For each Brand Family of roll-your-own tobacco being certified, state whether the NPM Applicant pays the Idaho OTP tax and provide a complete list of retailers to whom the rollyour-own tobacco is intended to be sold in Idaho. If the NPM Applicant intends to sell or authorize any other entity to sell any Cigarettes by mail order or through the Internet, provide the Internet website and identify the entity. Attach copies of all reports, if any, filed with the Idaho State Tax Commission to comply with Jenkins Act (Chapter 10A of Title 15 of the U.S. Code, Section 375 et seq.) for sales in the last 12 months. Attach copies of any agreement authorizing another to sell your Brand Families by mail order or through the Internet. For each Brand Family (cigarettes only) listed in Part 3 of the Idaho Non-Participating Manufacturer Certificate of Compliance form, provide the name and address of the entity that submitted the ingredient reporting information to the U.S. Secretary of Health and Human Services as required by the Federal Cigarette Labeling and Advertising Act (15 U.S.C. §1335a) and attach copies of all certificates of compliance. 6. 7. 8. 9. 10. For each Brand Family (cigarettes only) listed in Part 3 of the Idaho Non-Participating Manufacturer Certificate of Compliance form, provide a copy of the current FTC rotation plan approval letter and the name and address of the entity that filed the health warning rotation plan with the FTC. 11. Provide a list of States that have certified the NPM Applicant and the Brand Families certified. If any State has refused to list or removed the NPM Applicant or a Brand Family of the NPM Applicant from a State's directory, identify the State(s). IDAHO NON-PARTICIPATING MANUFACTURER INITIAL RESPONSE2 of 3 (revised 3/7/2008) American LegalNet, Inc. www.FormsWorkFlow.com B. NPM Applicants Located in Foreign Countries. Provide the information requested. On separate sheets of paper, respond to each question or indicate N/A. All attachments must indicate the request to which it corresponds. 1. Provide copies of all Custom Form 7501s for the sales year indicated for each Brand Family listed in Part 3 of the Idaho Non-Participating Manufacturer Certificate of Compliance form. 2. Provide a copy of the sworn statement that the NPM Applicant has timely submitted or has certified that it will timely submit ingredients to the Secretary of Health and Human Services as required by 19 U.S.C. §1681a (c)(1). 3. Provide a copy of the importer's certificate under penalty of perjury as required by 19 U.S.C. §1681a (c)(2) regarding the precise format of warnings and the rotation plan for health warnings. 4. Provide a copy of the trademark holder's certificate under penalty of perjury that it has not withdrawn consent to import into the United States as required by 19 U.S.C. §1681a (c)(3)(A) and a copy of the importer's certificate under penalty of perjury that the trademark owner has not withdrawn consent into the Unites States as required by 19 U.S.C. §1681a (c)(3)(B). 5. List the name, address, and contact information for all importers for the Brand Families listed in Part 3 of the Idaho Non-Participating Manufacturer Certificate of Compliance form. ________________________________________________________________________ Part 4: Authorized Designee and Representation Under penalty of perjury, I certify and declare that all of the statements and information contained in this Initial Response form, including attachments, are true, correct, accurate and complete in every particular, and that I am a person authorized to bind the NPM Applicant identif
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