FDA Form # |
Date |
Title |
Format |
Paper Copy or Contact Info. |
431a |
05/84 |
General Continuation Sheet |
|
PPF |
431d |
10/74 |
Bacteriological Record |
|
PPF |
431e |
03/80 |
Industrial Chemicals Worksheet |
|
PPF |
431f |
11/89 |
Quantity of Contents |
|
PPF |
431g |
08/85 |
Salmonella Record |
|
William Campanaro 301-827-1036 |
431h |
07/85 |
Shigella Record |
|
PPF |
431i |
10/85 |
Canned Food Continuation Sheet |
|
PPF |
431j |
08/85 |
Botulism Continuation Sheet |
|
William Campanaro 301-827-1036 |
431k |
08/85 |
Shellfish Bacteriological Record |
|
William Campanaro 301-827-1036 |
431m |
12/79 |
Elemental Analysis Worksheet |
|
PPF |
433 |
06/82 |
Tomato Inspection Report |
|
Gerald Blackwell 301-827-5639 |
701 |
01/89 |
Customs Form 3461 "Entry/Immediate
Delivery" |
|
Sammie Hadden 301-827-9632 |
1815 |
02/06 |
Certificate/ Transmittal for an
Application |
|
Esther Lazar 301-436-1485 |
1993 |
02/06 |
Application for Permit to Ship or
Transport Milk and/or Cream into US |
|
Esther Lazar 301-436-1485 |
1994 |
02/06 |
Report of Tuberculin Tests of Cattle
|
|
Ester
Lazar 301-436-1485 |
1995 |
02/06 |
Report of Physical Examination of Cows
|
|
Esther Lazar 301-436-1485 |
1996 |
02/06 |
Dairy Farm Sanitation Report |
|
Esther Lazar 301-436-1485 |
1997 |
02/06 |
Score Card for Sanitation Inspections of
Milk Plants |
|
Esther Lazar 301-436-1485 |
2359 |
10/06 |
Milk Plant Inspection Report |
|
Robert Hennes 301-436-2175 |
2359a |
10/06 |
Dairy Farm Inspection Report |
|
PPF |
2359b |
10/06 |
Milk Plant Equipment Tests Report |
|
Robert Hennes 301-436-2175 |
2359c |
01/06 |
Manufacturing Plant Inspection Report
|
|
PPF |
2359d |
10/06 |
Report of Certification |
|
PPF |
2359h |
10/06 |
Interstate Milk Shipper Check-Rating
Report |
|
PPF |
2359j |
03/01 |
Milk Sanitation Rating Report |
|
PPF |
2359k |
03/01 |
Status of Raw Milk for Pasteurization
|
|
Robert Hennes 301-436-2175 |
2359l |
03/01 |
Status of Milk Plants |
|
Robert Hennes 301-436-2175 |
2359m |
10/06 |
Milk Plant, Receiving Station or Transfer Station NCIMS HACPP System Audit Report |
|
Robert Hennes 301-436-2175 |
2359n |
10/06 |
NCIMS HACCP System Regulatory Agency Review Report |
|
Richard Eubanks
301-436-2174 |
2399 |
10/06 |
Dairy Plant Sampling - Raw &
Pasteurized Milk |
|
Robert Hennes 301-436-2175 |
2399a |
10/06 |
Bulk Milk Hauler/Sampler Evaluation Report |
|
Robert Hennes 301-436-2175 |
2399b |
10/06 |
Milk Tank Truck Inspection Report |
|
Robert Hennes 301-436-2175 |
2399c |
10/06 |
Farm Bulk Tank Milk Sampling Inspection
Record |
|
Robert Hennes 301-436-2175 |
2399d |
10/06 |
Dairy Plant - Milk Sample Collector Evaluation Record |
|
Robert Hennes 301-436-2175 |
2359i |
03/01 |
Interstate Milk Shipper Report |
|
Robert Hennes 301-436-2175 |
2400 h-1 |
03/01 |
MLEF Electronic Somatic Cell Count Foss
250/300/360/400 |
|
Thomas E. Graham, Ph.D. 708-728-4114 |
2400h-2 |
03/01 |
MLEF Electronic Somatic Cell Count
Bentley Somacount 150/300/500 |
|
Thomas E. Graham, Ph.D. 708-728-4114 |
2400h-3 |
03/01 |
MLEF Electronic Somatic Cell Count
Fossmatic 5000 |
|
Thomas E. Graham, Ph.D. 708-728-4114 |
2511 |
06/06 |
Registration of Cosmetic Product
Establishment {Instructions} |
|
VCRP 301-436-1130 |
2512 |
06/06 |
Cosmetic Product Ingredient Statement
{Instructions} |
|
VCRP 301-436-1130 |
2512a |
06/06 |
Cosmetic Product Ingredient Statement
{Instructions} |
|
VCRP 301-436-1130 |
2514 |
06/06 |
Notice of Discontinuance of Commercial
Distribution of Cosmetic Product Formulation
{Instructions} |
|
VCRP 301-436-1130 |
2541 |
10/05 |
Food Canning Registration
{Instructions} |
|
LACF Coordinator
LACF@FDA.HHS.GOV |
2541a |
08/05 |
Food Process Filing For All Methods
Except Low-Acid Aseptic {Instructions} |
|
LACF Coordinator
LACF@FDA.HHS.GOV |
2541c |
08/05 |
Food Process Filing For Low-Acid Aseptic
Systems {Instructions} |
|
LACF Coordinator
LACF@FDA.HHS.GOV |
2679 |
08/01 |
Food Warehouse Inspection Report |
|
Glen Johnson 301-827-2907 |
2681 |
02/02 |
Bakery Inspection Report |
|
Glen Johnson 301-827-2907 |
2682 |
08/01 |
Beverage Plant Inspection Report |
|
PPF |
2684 |
04/02 |
State Contract Monthly Food Report |
|
Preet Sudhaker 301-827-2908 |
2684a |
04/02 |
State Contract Monthly Feed Establishment
Report |
|
Preet Sudhaker 301-827-2908 |
2966 |
10/88 |
Food GMP Inspection Report |
|
PPF |
3038 |
03/07 |
Interstate Shellfish Dealer's
Certificate {ICSSL definition page link } |
{Not for public use, only for approved State shellfish officials to log into to set up a shellfish shipper user account to be able to fill out and submit the FDA 3038 electronically} |
Charlotte Epps 301-436-2154 |
3479 |
03/05 |
Notification for a Food Contact Substance
Formulation |
|
Francis Linn 301-436-1215 |
3480 |
09/05 |
Notification For New Use Of A Food
Contact Substance |
|
Francis Linn 301-436-1215 |
3500 |
02/06 |
MedWatch: The FDA Safety Information and Adverse Event Reporting Program {Instructions} |
|
MEDWATCH 1-800-FDA-1088 |
3500A |
02/06 |
MedWatch: The FDA Safety Information and Adverse Event Reporting Program - Mandatory {Instructions} |
|
MEDWATCH 1-800-FDA-1088 |
3501 |
01/07 |
Domestic Seafood (HACCP) Report |
|
Roshelle King
301-436-1416 |
3502 |
01/01 |
Importer Seafood HACCP Report |
Not Yet Electronic |
Roshelle King 301-436-1416 |
3503 |
09/07 |
Food Additive Petition Submission |
|
Maribeth LaVecchi 301-436-1211
|
3504 |
09/07 |
Color Additive Petition Submission |
|
Maribeth LaVecchi 301-436-1211 |
3511 |
03/07 |
FDA LACF Inspection Report |
|
Brian Hendrickson 317-226-6500
Ext. 104 |
3511-2 |
03/07 |
FDA Acidified Food Inspection Report
|
|
Brian Hendrickson 317-226-6500
Ext. 104 |
3511-3 |
03/07 |
Aseptic Processing & Packaging Report
|
|
Brian Hendrickson 317-226-6500
Ext. 104 |
3511a |
03/07 |
Processing in Steam in Still Retorts |
|
Brian Hendrickson 317-226-6500
Ext. 104 |
3511b |
03/07 |
Processing in Water in Still Retorts |
|
Brian Hendrickson 317-226-6500
Ext. 104 |
3511c |
03/07 |
Processing in Steam in Continuous Agitating Retorts |
|
Brian Hendrickson 317-226-6500
Ext. 104 |
3511d |
03/07 |
Processing in Steam in Discontinuous Agitating Retorts |
|
Brian Hendrickson 317-226-6500
Ext. 104 |
3511e |
03/07 |
Processing in Water in Discontinuous
Agitating Retorts |
|
Brian Hendrickson 317-226-6500
Ext. 104 |
3511f |
03/07 |
Processing in Steam in Hydrostatic
Retorts |
|
Brian Hendrickson 317-226-6500
Ext. 104 |
3511g |
03/07 |
Processing in Cascading/Spray Water
Retort |
|
Brian Hendrickson 317-226-6500
Ext. 104 |
3511h |
03/07 |
Processing in Other Unique Retort Systems |
|
Brian Hendrickson 317-226-6500
Ext. 104 |
3511i |
03/06 |
Processing in Steam-Air Retorts |
|
Brian Hendrickson 317-226-6500
Ext. 104 |
3537 |
05/07 |
Food Facility Registration
{Instructions} |
|
FDA Industry Systems Help Desk
800-216-7331
301-575-0156 |
3537a |
05/07 |
Cancellation of Food Facility
Registration {Instructions} |
|
FDA Industry Systems Help Desk
800-216-7331
301-575-0156 |
3540 |
05/07 |
Prior Notice Submission
{Instructions} |
|
Prior Notice Center
866-521-2297 |
3570 |
02/07 |
Model Small Business Food Labeling
Exemption Notice |
|
SBusiness 301-436-2375 |
3613d |
02/06 |
Office of Cosmetics and Colors "Certificate" Export Application |
|
Import/Export Team CFSAN 301-436-2776
|
3613e |
02/06 |
Food Export Certificate Application |
|
Import/Export Team CFSAN 301-436-2776
|
3717 |
4/08 |
Report of Inspection for Compliance with 21 CFR 589.2000 |
|
Shannon Jordre
240-276-9229
|