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PS 4616

PACT Application for Consumer Testing/Public Health Exception (7/2010)

Download and Print the PS 4616

Request may not be processed if the form is incomplete or illegible.

Eligibility Number: (USPS entry only - issued by PCSC upon approval of application.)

Consumer Testing Purposes: The Prevent All Cigarette Trafficking (PACT) Act permits a legally operating cigarette manufacturer or an authorized agent of a legally operating cigarette manufacturer to mail cigarettes to verified adult smokers solely for consumer testing purposes. The manufacturers for which mailings are entered under this exception must have a permit in good standing issued under 26 U.S.C. § 5713. Such mailings are subject to the conditions of Mailing Standards of the United States Postal Service, Domestic Mail Manual (DMM®), sections 601.11.7.1 to 601.11.7.3 (for cigarette manufacturers and their agents), and 601.11.8 (for federal government agencies involved in consumer testing of tobacco products solely for public health purposes).

Section A — Applicant

Answer the following questions. Please use additional sheets if necessary.

1. Names of manufacturer, agent of a manufacturer, or federal agency:

2. Street address:

1b. For agent of a manufacturer, describe relationship with the manufacturer:

2a. Mailing address (if different from street address):

PS Form 4616, July 2010, (Page 1 of 2)

a. Name and title:

3. City, State, ZIP Code:

4. Information about agent/employee completing the application:

b. Telephone number (include area code):

c. E-mail address:

6. Specify all Post Office locations (City, State, ZIP Code) where cigarettes will be presented.

5. Applicant

And much more...