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Clean Indoor Air Act Forms 

  • Clean Indoor Air Act Application for Exception for Cigar Bar, Drinking Establishment or Tobacco Shop - Use this form to apply for a smoking exception. CIAA Application Guidance Document
  • Event Exception Form - Use this form to notify the Department of Health of a fundraiser or facility at which smoking will occur.
  • Private Club Reporting Form - Use this form to report the result of a vote of a private club to allow smoking.


The Department renews annual Clean Indoor Air Act (CIAA) exceptions each month according to the location of the establishments.  The Department uses the Pennsylvania Liquor Control Board (PLCB)'s districts to determine the renewal month for each annual exception.  CIAA exceptions are due for renewal during the same month as an establishment's liquor license.  For those establishments without liquor licenses (Tobacco Shops), renewals are still due according to this schedule.

The Department mails renewal applications to establishments with exceptions annually.  An establishment will be mailed a new letter and certificate each year if they continue to meet CIAA exception criteria.  Establishments may visit the CIAA website (click on "List of Businesses with a CIAA Exception") to confirm they are still listed as having a valid CIAA exception. 

CIAA exceptions are not renewed if:

  • An establishment fails to submit their renewal application to the Department by the due date,
  • Sales figures reported exceed the required percentage for the exception type, or
  • The liquor license is not active according to the PLCB website (for Drinking Establishment and Cigar Bar exceptions only).

For Drinking Establishment exception holders, this renewal application process includes an internal review including one or more of the following steps:

  1. Verifying active liquor license status with the Pennsylvania Liquor Control Board (PLCB), and
  2. Verifying that the percentage of food sales for the smoking area of your establishment is at or below 20%.

For Tobacco Shop exception holders, the internal review includes verifying that the percentage of tobacco and tobacco-related products is at or above 50% of the gross annual sales.

For Cigar Bar Exception holders, this internal review includes one or more of the following steps:

  1. Verifying active liquor license status with the PLCB, and
  2. Verifying that the percentage of tobacco and tobacco-related products are at least 15% of the combined gross annual sales of the establishment.

The Department requires a renewal application to be submitted each year.  Business owners may submit this information to the Department by completing the blank renewal application sent to you from the Department approximately one month before your exception expires.  Mail, fax or e-mail the completed form to the Department before the due date listed in the letter that accompanies the blank form.  If you need another copy of the blank sales form, select the type of exception you have below:

Please note: At this time, all establishments must submit the renewal application, even if selecting the CIAA feature when using E-Tides to report to Revenue. 

If you miss the deadline to submit your renewal application to the Department,  your exception will be denied.  Please see the information flyer on a change in CIAA renewal denial appeal procedures effective January 1, 2018.

If you have any questions, please contact the Division of Tobacco Prevention and Control:

625 Forster Street
Room 1032 
Health & Welfare Building
Harrisburg, PA 17120
Phone:  717-783-6600
Fax: 717-214-6690