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FDA's Electronic Forms
Alphabetical Listing

The forms provided by this web site are available in several formats. These formats include:

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MS
				
				
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EXCEL Microsoft Excel
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Fillable Filler Forms

For more information on using these tools please refer to NOTEs at the bottom of the page.

If you wish to add a form, please contact Elizabeth Sands at 301-827-1480.

Questions, contact industry support.

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Food and Drug Administration Forms
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FDA Form # Date Title Format Paper Copy or Contact Info.
3663 07/07 Abbreviated Reports on Radiation Safety for Microwave Products (Other than Microwave Ovens)
PDF
DMQRP
240-276-3332
3069 10/80 Above Table X-Ray Source Fluoroscopic & Spot Film Systems Field Test Record
PDF
PPF
2784 10/80 Above Table X-Ray Source Radiographic {2784.1-Pg1, 2784.2-Pg2, 2784.3-Pg3} Systems
PDF
PPF
3623b 11/05 Additional Sets of Workers
PDF

PDF_508

Word
Barbara Marcelletti
301-827-5635
3623a 11/05 Additional Water Sources
PDF

PDF_508

Word
Barbara Marcelletti
301-827-5635
3662 07/07 A Guide for Submission of an Abbreviated Radiation Safety Reports on Cephalometric Devices Intended for Diagnostic Use
PDF
DMQRP
240-276-3332
3661 07/07 A Guide for the Submission of an Abbreviated Report on X-ray Tables, Cradles, Film Changers or Cassette Holders Intended for Diagnostic Use
PDF
DMQRP
240-276-3332
3626 07/07 A Guide for the Submission of Initial Reports on Diagnostic X-ray Systems and Their Major Components
PDF
DMQRP
240-276-3332
431 05/84 Analyst Worksheet
Word
PPF
3546 02/04 ADUFA User Fee Cover Sheet
HTML
Helio Chaves
301-827-3912
766 12/04 Application for Authorization to Re label or to Perform Other Action of the Federal Food, Drug, and Cosmetic Act and Other Related Acts
PDF

Word
Domenic Veneziano
301-443-6553
3147 05/07 Application for a Variance From 21 CFR 1040.11(c) for a Laser Light Show, Display, or Device
PDF
DMQRP
240-276-3332
1993 02/06 Application for Permit to Ship or Transport Milk and/or Cream into US
PDF

Word
Ester Lazar
301-436-1485
356h 10/05 Application to Market a New Drug, Biologic or an Antibiotic Drug for Human Use Fillable P D F CBER MATT at 301-827-2000
CDER Drug Info at 301-796-3400
3511-3 03/07 Aseptic Processing & Packaging Report
Word
Brian Hendrickson
317-226-6500
Ext. 104
3611 09/03 Audit Report
PDF

Word
Beverly Kent
716-541-0331
1570a 04/78 Bacteriological Definitions
PDF

Word
William Campanaro
301-827-1036
431d 10/74 Bacteriological Record
PDF
PPF
2681 02/02 Bakery Inspection Report
PDF

WORD
Glen Johnson
301-827-2907
2682 08/01 Beverage Plant Inspection Report
PDF

Word
PPF
3486 08/07 Biological Product Deviation Report{Instructions}
Fillable P D F

HTML
CBER Surveillance Branch
301-827-6220
2830 07/06 Blood Establishment Registration and Product Listing
Fillable P D F

Word

HTML
bloodregis@fda.hhs.gov
431j 08/85 Botulism Continuation Sheet
PDF
William Campanaro
301-827-1036
3316a 08/85 Blue - DRUG MASTER FILE ARCHIVAL BINDER Not Yet Electronic GPO
2399a 10/06 Bulk Milk Hauler/Sampler Evaluation Report
PDF

Word
Robert Hennes
301-436-2175
3641 07/07 Cabinet X-Ray Annual Report
PDF
DMQRP
240-276-3332
3537a 05/07 Cancellation of Food Facility Registration {Instructions}
PDF

HTML
FDA Industry Systems Help Desk
800-216-7331
301-575-0156
431i 10/85 Canned Food Continuation Sheet
PDF
PPF
3260 02/83 C-Arm Fluoroscopic & Spot-Film Systems Field Test Record
PDF
PPF
3437 06/95 CDER Pediatric Use Supplement
PDF
CDR
301-827-4210
3514 03/08 CDRH Premarket Review Submission Cover Sheet PDF Bob Gatling
240-276-4015
1815 02/06 Certificate/ Transmittal for an Application
PDF

Word
Esther Lazar
301-436-1485
3454 04/06 Certification: Financial Interest and Arrangements of Clinical Investigators
PDF

Word
Leah W. Ripper
301-796-1282
3674 11/08 Certification of Compliance, under 42 U.S.C. , 282(j)(5)(B), with Requirements of ClinicalTrials.gov Data Bank (42 U.S.C., 282(j)) PDF_508 Jarilyn Dupont
301-827-3360
3504 09/07 Color Additive Petition Submission Maribeth LaVecchi
301-436-1211
3671 11/07 Common EMEA/FDA Application for Orphan Medicinal Product Designation
pdf

PDF_508

WORD
Kathy Needleman
301-827-3666
3410 10/01 Confidential Financial Disclosure Report
PDF

Word
Vincent Tolino
301-827-5514
3610 10/03 Contract Audit
PDF

Word
Beverly Kent
716-541-0331
3131 08/01 Contract Property Administration Completion Report
PDF
Mike McGrath
301-827-7105
2512a 06/06 Cosmetic Product Ingredient Statement{Instructions}
PDF

Word
VCRP
301-436-1257
2512 06/06 Cosmetic Product Ingredient Statement {Instructions}
PDF

Word
VCRP
301-436-1257
2400 03/01 Cultural Procedures - General Requirements
PDF
Thomas E. Graham, Ph.D.
708-728-4114
2359a 10/06 Dairy Farm Inspection Report
PDF

Word
PPF
1996 02/06 Dairy Farm Sanitation Report
PDF

Word
Esther Lazar
301-436-1485
2399d 10/06 Dairy Plant - Milk Sample Collector Evaluation Record
PDF

Word
Robert Hennes
301-436-2175
2399 10/06 Dairy Plant Sampling - Raw & Pasteurized Milk
PDF

Word
Robert Hennes
301-436-2175
2877 12/03 Declaration for Imported Electronic Products Subject to Radiation Control Standards
PDF

Word
DMQRP
240-276-3332
2785 05/82 Dental Radiographic Systems Field Test Record
PDF
PPF
3627 07/07 Diagnostic X-Ray CT Products Radiation Safety Report
PDF
DMQRP
240-276-3332
3455 04/06 Disclosure: Financial Interest and Arrangements of Clinical Investigators
PDF

Word
Leah W. Ripper
301-796-1282
3501 01/07 Domestic Seafood (HACCP) Report
HTML
Roshelle King
301-436-1416
2657 02/08 Drug Product Listing {Instructions} PDF DRLS
drls@fda.hhs.gov or 301-210-2840
3463 07/00 EDI Gateway Training Partner Agreement Not Yet Electronic Bill Taylor
301-827-6504
3538 07/07 Electronic Submission System Participant Password or Addition {Instructions}
PDF
Margaret Zabriski
240-276-9143
431m 12/79 Elemental Analysis Worksheet
PDF
PPF
3356 04/08 Establishment Registration and Listing for Human Cells, Tissues, and Cellular and Tissue-Based Products (HCT/Ps) Fillable P D F

HTML
tissuereg@fda.hhs.gov
2399c 10/06 Farm Bulk Tank Milk Sampling Inspection Record
PDF

Word
Robert Hennes
301-436-2175
3623 11/05 Farm Investigation Questionnaire
PDF

PDF_508

WORD
Barbara Marcelletti
301-827-5635
3511-2 03/07 FDA Acidified Food Inspection Report
PDF

Word
Brian Hendrickson
317-226-6500
Ext. 104
3511 03/07 FDA LACF Inspection Report
Word
Brian Hendrickson
317-226-6500
Ext. 104
2814 08/93 Field Equipment Request
PDF

Word
William Campanaro
301-827-1036
2782 09/98 Field Test Record Continuation Sheet
PDF

Word
Richard Barnes
301-827-2905
3503 09/07 Food Additive Petition Submission
PDF

MS WORD
Maribeth LaVecchi
301-436-1211
2541 10/05 Food Canning Registration {Instructions} HTML LACF Coordinator
LACF@FDA.HHS.GOV
3613e 02/06 Food Export Certificate Application
PDF

Word
Import/Export Team
CFSAN 301-436-2776
3537 05/07 Food Facility Registration {Instructions}
PDF

HTML
FDA Industry Systems Help Desk
800-216-7331
301-575-0156
2966 10/88 Food GMP Inspection Report
PDF

Word
PPF
2541a 08/05 Food Process Filing For All Methods Except Low-Acid Aseptic {Instructions} HTML LACF Coordinator
LACF@FDA.HHS.GOV
2541c 08/05 Food Process Filing For Low-Acid Aseptic Systems {Instructions} HTML LACF Coordinator
LACF@FDA.HHS.GOV
2679 08/01 Food Warehouse Inspection Report
PDF

Word
Glen Johnson
301-827-2907
431a 05/84 General Continuation Sheet
PDF

Word
PPF
3429 01/03 General Device Classification Questionnaire
PDF

Word
Marjorie Shulman
240-276-4040
3071 04/01 General Information Field Test Record
PDF

Word
PPF
3422 08/07 Government Entity Declaration
PDF

Word
Denise Robinson
240-276-3278
3660 07/07 Guidance for Preparing Reports on Radiation Safety of Microwave Ovens
PDF
DMQRP
240-276-3332
3639 07/07 Guidance for Submission of Cabinet X-Ray System Reports Pursuant to 21 CFR 1020.40
PDF
DMQRP
240-276-3332
3638 07/07 Guide for Filling Annual Reports for X-Ray Components and Systems
PDF
DMQRP
240-276-3332
3636 07/07 Guide for Preparing Annual Reports on Radiation Safety Testing of Laser and Laser Light Show
PDF
DMQRP
240-276-3332
3647 07/07 Guide for Preparing Annual Reports on Radiation Safety Testing of Mercury Vapor Lamps
PDF
DMQRP
240-276-3332
3631 07/07 Guide for Preparing Annual Reports on Radiation Safety Testing of Sunlamps and Sunlamp Products
PDF
DMQRP
240-276-3332
3644 07/07 Guide for Preparing Product Reports for Ultrasonic Therapy Products
PDF
DMQRP
240-276-3332
3645 07/07 Guide for Preparing Annual Reports for Ultrasonic Therapy Products
PDF
DMQRP
240-276-3332
3632 07/07 Guide for Preparing Product Reports on Lasers and Products Containing Lasers
PDF
DMQRP
240-276-3332
3630 07/07 Guide for Preparing Product Reports on Sunlamps and Sunlamp Products
PDF
DMQRP
240-276-3332
3297 04/01 Head and Neck Radiographic Systems Field Test Record
PDF
PPF
3502 01/01 Importer Seafood HACCP Report Not Yet Electronic Roshelle King
301-436-1416
359v 06/90 INAD Folder (VET) Not Yet Electronic David Newkirk
301-827-6967
431e 03/80 Industrial Chemicals Worksheet
PDF
PPF
3571 06/06 Infusion Pump Information Submission Report {Instructions}
PDF

Word
Morgan Warner
240-276-3461
2589 08/01 Inspection Summary - Bus Service Area Sanitation
PDF
PPF
2591 08/01 Inspection Summary - Equipment Evaluation
PDF
PPF
2359h 10/06 Interstate Milk Shipper Check-Rating Report
PDF

WORD
PPF
2359i 10/06 Interstate Milk Shipper Report
PDF

WORD
PPF
3038 03/07 Interstate Shellfish Dealer's Certificate {ICSSL definition page link } Charlotte Epps
301-436-2154
1571 04/06 Investigational New Drug Application {Instructions}
CBER
CBER MATT at 301-827-2000
CDER Drug Info at 301-796-3400
2675a 10/86 Investigational New Drug Folder (Green) Not Yet Electronic GPO
2675b 10/86 Investigational New Drug Folder (Orange) Not Yet Electronic GPO
2675 08/90 Investigational New Drug Folder (Red) Not Yet Electronic GPO
2196 07/87 Laboratory Management Coding Sheet
PDF
PPF
3070 08/92 Mammography Systems Field Test Record
PDF
PPF
2359c 10/06 Manufacturing Plant Inspection Report (Single-Service Milk Containers and Closures)
PDF

Word
PPF
3602 10/08 FY MDUFMA Small Business Qualification Certification For a Business Headquarter in the United States
pdf
James G. Norman
240-276-3806
3602a 10/08 FY MDUFMA Small Business Qualification Certification For a Business Headquarter Outside the United States
pdf
James G. Norman
240-276-3806
3608 06/05 Medical Device Fellowship Program Student Application {Instructions}
HTML
Medical Device Fellowship Program
240-276-3816
3419 10/07 Medical Device Reporting Annual User Facility Report {Instructions}
PDF

Word
OSB/CDRH/RSMB
240-276-3464
3601 01/07 Medical Device User Fee Cover Sheet
HTML
User Fees Financial Support Team
301-827-9539
3448 09/07 Medicated Feed Mill License Application
PDF

Word
Jo W. Gulley
240-453-6858
3670 03/08 MedSun (Medical Product Surveillance Network)
HTML
Marilyn Flack
240-276-2391
3500 02/06 MedWatch: The FDA Safety Information and Adverse Event Reporting Program {Instructions}
PDF-Fillable

HTML
MEDWATCH
1-800-FDA-1088
3500A 02/06 MedWatch: The FDA Safety Information and Adverse Event Reporting Program - Mandatory {Instructions}
PDF-Fillable
MEDWATCH
1-800-FDA-1088
3646 07/07 Mercury Vapor Lamp Products Radiation Safety Report
PDF
DMQRP
240-276-3332
3643 07/07 Microwave Oven Products Annual Report
PDF
DMQRP
240-276-3332
2400a-1 03/01 Milk Laboratory Evaluation Form: Spiral Plate Count Methods
PDF
Thomas E. Graham, Ph.D.
708-728-4114
2400a 03/01 Milk Laboratory Evaluation Form: Standard Plate Count, Coliform, and Simplified Count Methods
PDF
Thomas E. Graham, Ph.D.
708-728-4114
2359b 10/06 Milk Plant Equipment Tests Report
PDF

WORD
Robert Hennes
301-436-2175
2359 10/06 Milk Plant Inspection Report
PDF

PDF_508

WORD
Robert Hennes
301-436-2175
2359m 10/06 Milk Plant, Receiving Station or Transfer Station NCIMS HACPP System Audit Report
PDF

WORD
Robert Hennes
301-436-2175
2359j 10/06 Milk Sanitation Rating Report
PDF
PPF
2399b 10/06 Milk Tank Truck Inspection Report
PDF

Word
Robert Hennes
301-436-2175
3677v 1/06 Minor Species Index File (MIF) Not Electronic Yet Joan C. Gotthardt
240-276-9331
2400m 03/01 MLEF Dairy Waters
PDF
Thomas E. Graham, Ph.D.
708-728-4114
2400b-1 03/01 MLEF Detection of Inhibitory Substances in Milk Bacillus Stearothermophilus
PDF
Thomas E. Graham, Ph.D.
708-728-4114
2400b-3 03/01 MLEF Detection of Inhibitory Substances in Milk Delvotest 5 Pack
PDF
Thomas E. Graham, Ph.D.
708-728-4114
2400b 05/87 MLEF Detention of Inhibitory Substances in Milk Not Yet Electronic Thomas E. Graham, Ph.D.
708-728-4114
2400d 03/01 MLEF Direct Microscopic Somatic Cell Count
PDF
Thomas E. Graham, Ph.D.
708-728-4114
2400l 03/01 MLEF Disintegration Method for Paper, etc.
PDF
Thomas E. Graham, Ph.D.
708-728-4114
2400h-2 03/01 MLEF Electronic Somatic Cell Count Bentley Somacount 150/300/500
PDF
Thomas E. Graham, Ph.D.
708-728-4114
2400 h-1 03/01 MLEF Electronic Somatic Cell Count Foss 250/300/360/400
PDF
Thomas E. Graham, Ph.D.
708-728-4114
2400h-3 03/01 MLEF Electronic Somatic Cell Count Fossmatic 5000
PDF
Thomas E. Graham, Ph.D.
708-728-4114
2400k 03/01 MLEF Flat Lid Methods
PDF
Thomas E. Graham, Ph.D.
708-728-4114
2783 10/80 Mobile Radiographic Systems Field Test Record
PDF
PPF
3570 02/07 Model Small Business Food Labeling Exemption Notice
HTML
SBusiness
301-436-2375
3664 07/07 My Medicine Record {Instructions}
PDF

Word
Cindi Fitzpatrick
301-796-3115
358v 03/89 NADA Folders (VET) Not Yet Electronic David Newkirk
301-827-6967
2359n 10/06 NCIMS HACPP System Regulatory Agency Review Report (To be included with all NCIMS HACCP Listings and FDA Audits)
PDF

WORD
Robert Hennes
301-436-2175
3331 04/06 NDA Field Alert Report
PDF

Word
Juliaette Johnson
301-827-8928
356v 04/08 New Animal Drug Application [VET] {Q&As on the Revised 356v Form}
PDF
Katherine Weld

240-276-8301
2626 07/04 New Drug Application/Biologic Licensing Application (Blue Folder) Archival Not Yet Electronic GPO
2626a 07/04 New Drug Application/Biologic Licensing Application (Red Folder) Chemistry Not Yet Electronic GPO
2626e 07/04 New Drug Application/Biologic Licensing Application (Tan Folder) Clinical Data Not Yet Electronic GPO
2626h 07/04 New Drug Application/Biologic Licensing Application (Maroon Folder) Field Submission Chemistry Not Yet Electronic GPO
2626d 07/04 New Drug Application/Biologic Licensing Application (White Folder) Microbiology Not Yet Electronic GPO
2626c 07/04 New Drug Application/Biologic Licensing Application (Orange Folder) Pharmacokinetic Not Yet Electronic GPO
2626b 07/04 New Drug Application/Biologic Licensing Application (Yellow Folder) Pharmacology Not Yet Electronic GPO
2626f 07/04 New Drug Application/Biologic Licensing Application (Light Green Folder) Statistics Not Yet Electronic GPO
2767 05/07 Notice of Availability of Sample Electronic Product
PDF

Word
DMQRP
240-276-3332
3458 07/07 Notice of Claimed Investigational Exemption (electronic) {Instructions}
PDF
Margaret Zabriski
240-276-9143
2514 06/06 Notice of Discontinuance of Commercial Distribution of Cosmetic Product Formulation {Instructions}
PDF

Word
VCRP
301-436-1257
3487 07/07 Notice of Final Disposition of Animals not Intended for Immediate Slaughter {Instructions}
PDF
Margaret Zabriski
240-276-9143
3488 07/07 Notice of Intent to Slaughter for Human Food Purposes {Instructions}
PDF
Margaret Zabriski
240-276-9143
3479 03/05 Notification for a Food Contact Substance Formulation
PDF

Word
Francis Linn
301-436-1215
3480 09/05 Notification For New Use Of A Food Contact Substance
PDF

Word
Francis Linn
301-436-1215
3613d 02/06 Office of Cosmetics and Colors "Certificate" Export Application
PDF

Word
Import/Export Team
CFSAN 301-436-2776
2400i 03/01 Pasteurized Milk Containers
PDF
Thomas E. Graham, Ph.D.
708-728-4114
3542 07/07 Patent Information Submitted Upon and After Approval of An NDA or Supplement
PDF
Mary Ann Holovac
240-276-8971
3542a 07/07 Patent Information Submitted With the Filing of An NDA, Amendment, or Supplement
PDF

Word
Mary Ann Holovac
240-276-8971
3068 08/92 Peak Kilovoltage Determination Field Test Record
PDF
PPF
2359o 10/06 Permission for Publication Interstate Milk Shipper's Listing
PDF

WORD
Robert Hennes
301-436-2175
2400j 03/01 Phosphatase Test
PDF
Thomas E. Graham, Ph.D.
708-728-4114
3541 09/07 Premarket Notification [510(K)] Status Request and Response
PDF

PDF_508

Word
John Stigi
240-276-3150 EX 124
3540 05/07 Prior Notice Submission {Instructions}
HTML
Prior Notice Center
866-521-2297
3511g 03/07 Processing in Cascading/Spray Water Retort
PDF

Word
Brian Hendrickson
317-226-6500
Ext. 104
3511i 03/06 Processing in Other Unique Retort Systems
PDF

Word
Brian Hendrickson
317-226-6500
Ext. 104
3511h 03/07 Processing in Steam-Air Retorts
PDF

Word
Brian Hendrickson
317-226-6500
Ext. 104
3511c 03/07 Processing in Steam in Continuous Agitating Retorts
PDF

Word
Brian Hendrickson
317-226-6500
Ext. 104
3511d 03/07 Processing in Steam in Discontinuous Agitating Retorts
PDF

Word
Brian Hendrickson
317-226-6500
Ext. 104
3511f 03/07 Processing in Steam in Hydrostatic Retorts
PDF

Word
Brian Hendrickson
317-226-6500
Ext. 104
3511a 03/07 Processing in Steam in Still Retorts
PDF

Word
Brian Hendrickson
317-226-6500
Ext. 104
3511c 03/06 Processing in Steam in Continuous Agitating Retorts
PDF

Word
Brian Hendrickson
317-226-6500
Ext. 104
3511d 03/06 Processing in Steam in Discontinuous Agitating Retorts
PDF

Word
Brian Hendrickson
317-226-6500
Ext. 104
3511f 03/07 Processing in Steam in Hydrostatic Retorts
PDF

Word
Brian Hendrickson
317-226-6500
Ext. 104
3511e 03/07 Processing in Water in Discontinuous Agitating Retorts
PDF

Word
Brian Hendrickson
317-226-6500
Ext. 104
3511b 03/07 Processing in Water in Still Retorts
PDF
Brian Hendrickson
317-226-6500
Ext. 104
3536 07/07 Protocol for Non-Clinical Laboratory and Effectiveness Studies{Instructions}
PDF
Margaret Zabriski
240-276-9143
431f 11/89 Quantity of Contents
PDF
PPF
2915 08/086 Radioactive Drug Research Committee (RDRC) Report on Research Use of Radioactive Drugs Study Summary PDF_508 RDRC
301-796-2050
2914 08/08 Radioactive Drug Research Committee (RDRC) Report on Research Use of Radioactive Drugs Membership Summary PDF_508 RDRC
301-796-2050
3316 08/85 Red - DRUG MASTER FILE REVIEW BINDER Not Yet Electronic GPO
2658 08/07 Registered Establishments Report of Private Label Distributors{Instructions}
PDF
DRLS
drls@fda.hhs.gov or 301-210-2840
2511 06/06 Registration of Cosmetic Product Establishment {Instructions}
PDF

Word
VCRP
301-436-1257
2656 08/07 Registration of Drug Establishment/Labeler Code Assignment {Instructions} THIS FORM MUST BE SUBMITTED IN TRIPLICATE
PDF

Word
DRLS
drls@fda.hhs.gov or 301-210-2840
2096 03/04 Regulation Certification for New Employee
PDF

Word
Vincent Tolino
301-827-5514
2097 01/03 Regulation Certification for Separating Employees
PDF

Word
Vincent Tolino
301-827-5514
2098 11/02 Regulation Certification for Special Government Employees
PDF
Vincent Tolino
301-827-5514
3659 07/07 Reporting and Compliance Guide for Television Products
PDF
DMQRP
240-276-3332
3640 07/07 Reporting Guide for Laser Light Shows and Displays
PDF
DMQRP
240-276-3332
2579 06/08 Report of Assembly of a Diagnostic X-Ray System
Word
PPF
2359d 10/06 Report of Certification
PDF

WORD
PPF
3717 4/08 Report of Inspection for Compliance with 21 CFR 589.2000 Fillable P D F Shannon Jordre
240-276-9229
1995 02/06 Report of Physical Examination of Cows
PDF

Word
Esther Lazar
301-436-1485
1551b 01/93 Report of Sample Analysis (Aflatoxins)
PDF

Word
PPF
1551 02/06 Report of Sample Analysis
Word

Word
PPF
1994 02/06 Report of Tuberculin Tests of Cattle
PDF

Word
Esther Lazar
301-436-1485
3489 07/07 Request for a Meeting or Teleconference {Instructions}
PDF
Margaret Zabriski
240-276-9143
1609a 03/86 Research Progress Record
PDF

Word
William Campanaro
301-827-1036
1609 03/86 Research Project Record
PDF

Word
William Campanaro
301-827-1036
1533 10/01 Results of Sediment Pad Grading
PDF
Norman Fogg
301-827-5645
3539 04/06 Review/Approval of Free Attendance at Widely Attended Gatherings (WAG)
PDF

Word
Vincent Tolino
301-827-5514
431g 08/85 Salmonella Record
PDF
William Campanaro
301-827-1036
421 07/03 Sample Accountability Record (ORA)
PDF

Word
PPF
465 08/85 Sample Summary
Word
PPF
1997 02/06 Score Card for Sanitation Inspections of Milk Plants
PDF

Word
Esther Lazar
301-436-1485
431k 08/85 Shellfish Bacteriological Record
PDF
William Campanaro
301-827-1036
431h 07/85 Shigella Record
PDF
PPF
3654 09/07 Standards Data Report for 510(K)s
PDF

Word
Bob Gatling
240-276-4015
2684a 04/02 State Contract Monthly Feed Establishment Report
PDF

Word
Preet Sudhaker
301-827-2908
2684 04/02 State Contract Monthly Food Report
PDF

Word
Preet Sudhaker
301-827-2908
1572 05/06 Statement of Investigator {Instructions-CBER} {Instructions-CDER}
PDF

PDF_508

Word
CBER MATT at 301-827-2000
CDER Drug Info at 301-796-3400
2359l 10/06 Status of Milk Plants
PDF

Word
Robert Hennes
301-436-2175
2359k 10/06 Status of Raw Milk for Pasteurization
PDF

WORD
Robert Hennes
301-436-2175
1570 04/78 Summary of Bacteriological Results
PDF

Word
William Campanaro
301-827-1036
3427 01/03 Supplemental Data Sheet
PDF

Word
Marjorie Shulman
240-276-4040
3613a 09/06 Supplementary Information Certificate of Exportability Requests
PDF

Word
Import/Export Team
CBER 301-827-6201 or CDRH 240 276-0132 or CVM 240-276-0132
3613b 06/06 Supplementary Information Certificate of a Pharmaceutical Product
PDF

Word
Import/Export Team
CBER 301-827-6201 or CDER 301-827-8940 or CVM 240-276-0132
3613 09/06 Supplementary Information Certificate to Foreign Government Requests
PDF

Word
Import/Export Team
CBER 301-827-6201 or CDRH 240 276-0132 or CVM 240-276-0132
3613c 09/06 Supplementary Information Non-Clinical Research Use Only Certificate
PDF

Word
Import/Export Team
CBER 301-827-6201 or CDRH 240 276-0132
3634 07/07 Television Products Annual Report
PDF
DMQRP
240-276-3332
433 06/82 Tomato Inspection Report
PDF
Norman Fogg
301-827-5645
2253 06/08 Transmittal of Advertisements and Promotional Labeling for Drugs and Biologics for Human Use PDF_508 DDMAC
301-796-1200
2252 06/08 Transmittal of Annual Report for Drugs and Biologics for Human Use PDF_508 CBER MATT at 301-827-2000
CDER Drug Info at 301-796-3400
2567 10/05 Transmittal of Labels and Circulars
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CBER MATT
301-827-2000
2301 03/07 Transmittal of Periodic Reports and Promotional Material for New Animal Drugs
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Pamela Esposito
240-276-9067
2786 05/82 Under Table X-Ray Source Fluoroscopic & Spot Film Systems Field Test Record
PDF
Richard Barnes
301-827-2905
3397 01/07 User Fee Cover Sheet
HTML
Mike Jones
301-443-5151
VAERS-1   Vaccine Adverse Event Reporting System{Instructions}
PDF

HTML
VAERS
800-822-7967
3261 02/83 Vertical Mount Cassette Holder Radiographic Systems Field Test Record
PDF
PPF
1932 01/07 Veterinary Adverse Drug Reaction, Lack of Effectiveness, Product Defect Report
PDF

PDF 508

WORD
Pamela Esposito
240-276-9067
1932a 03/07 Veterinary Adverse Drug Reaction, Lack of Effectiveness or Product Defect Report
PDF

PDF 508

Word
Pamela Esposito
240-276-9067

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Edition: January 8, 2009

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