FDA Home Page | Search FDA
Site | FDA A-Z Index |
Contact FDA FDA Forms Distribution
Page
|
FDA Form # | Date | Title | Format | Paper Copy or Contact Info. |
---|---|---|---|---|
421 | 07/03 | Sample Accountability Record (ORA) | PPF | |
431 | 05/84 | Analyst Worksheet | PPF | |
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 | Norman Fogg 301-827-5645 |
|
465 | 08/85 | Sample Summary | PPF | |
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 | Domenic Veneziano 301-443-6553 |
|
1533 | 10/01 | Results of Sediment Pad Grading | Norman Fogg 301-827-5645 |
|
1551 | 02/06 | Report of Sample Analysis | PPF | |
1551b | 01/93 | Report of Sample Analysis (Aflatoxins) | PPF | |
1570 | 04/78 | Summary of Bacteriological Results | William Campanaro 301-827-1036 |
|
1570a | 04/78 | Bacteriological Definitions | William Campanaro 301-827-1036 |
|
1609 | 03/86 | Research Project Record | |
William Campanaro 301-827-1036 |
1609a | 03/86 | Research Progress Record |
|
William Campanaro 301-827-1036 |
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 | Esther 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 |
|
2196 | 07/87 | Laboratory Management Coding Sheet | PPF | |
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 | 10/08 | Manufacturing Plant Inspection Report | PPF | |
2359d | 10/06 | Report of Certification | PPF | |
2359h | 10/06 | Interstate Milk Shipper Check-Rating Report | PPF | |
2359i | 10/06 | Interstate Milk Shipper Report | Robert Hennes 301-436-2175 |
|
2359j | 06/04 | Milk Sanitation Rating Report | PPF | |
2359k | 10/06 | Status of Raw Milk for Pasteurization | Robert Hennes 301-436-2175 |
|
2359l | 10/05 | 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 |
2400 | 03/01 | Cultural Procedures - General Requirements | Thomas E. Graham, Ph.D. 708-728-4114 |
|
2400a | 03/01 | Milk Laboratory Evaluation Form: Standard Plate Count, Coliform, and Simplified Count Methods | Thomas E. Graham, Ph.D. 708-728-4114 |
|
2400a-1 | 03/01 | Milk Laboratory Evaluation Form: Spiral Plate Count Methods | 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 |
2400b-1 | 03/01 | MLEF Detection of Inhibitory Substances in Milk Bacillus Stearothermophilus | Thomas E. Graham, Ph.D. 708-728-4114 |
|
2400b-3 | 03/01 | MLEF Detection of Inhibitory Substances in Milk Delvotest 5 Pack | Thomas E. Graham, Ph.D. 708-728-4114 |
|
2400d | 03/01 | MLEF Direct Microscopic Somatic Cell Count | Thomas E. Graham, Ph.D. 708-728-4114 |
|
2400h | 03/01 | Optical Somatic Cell Count | Thomas E. Graham, Ph.D. 708-728-4114 |
|
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 |
|
2400i | 03/01 | Pasteurized Milk Containers | Thomas E. Graham, Ph.D. 708-728-4114 |
|
2400j | 03/01 | Phosphatase Test | Thomas E. Graham, Ph.D. 708-728-4114 |
|
2400k | 03/01 | MLEF Flat Lid Methods | Thomas E. Graham, Ph.D. 708-728-4114 |
|
2400l | 03/01 | MLEF Disintegration Method for Paper, etc. | Thomas E. Graham, Ph.D. 708-728-4114 |
|
2400m | 03/01 | MLEF Dairy Waters | Thomas E. Graham, Ph.D. 708-728-4114 |
|
2589 | 08/01 | Inspection Summary - Bus Service Area Sanitation | PPF | |
2591 | 08/01 | Inspection Summary - Equipment Evaluation | PPF | |
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 |
2782 | 09/98 | Field Test Record Continuation Sheet | |
Richard Barnes 301-827-2905 |
2783 | 10/80 | Mobile Radiographic Systems Field Test Record | PPF | |
2784 | 05/82 | Above Table X-Ray Source Radiographic Systems | PPF | |
2785 | 05/82 | Dental Radiographic Systems Field Test Record | PPF | |
2786 | 05/82 | Under Table X-Ray Source Fluoroscopic & Spot Film Systems Field Test Record | Richard Barnes 301-827-2905 |
|
2814 | 08/93 | Field Equipment Request |
|
William Campanaro 301-827-1036 |
2966 | 10/88 | Food GMP Inspection Report | |
PPF |
3068 | 08/92 | Peak Kilovoltage Determination Field Test Record | PPF | |
3069 | 10/80 | Above Table X-Ray Source Fluoroscopic & Spot Film Systems Field Test Record | PPF | |
3070 | 08/92 | Mammography Systems Field Test Record | PPF | |
3071 | 04/01 | General Information Field Test Record |
|
PPF |
3131 | 08/01 | Contract Property Administration Completion Report | Mike McGrath 301-827-7105 |
|
3260 | 02/83 | C-Arm Fluoroscopic & Spot-Film Systems Field Test Record | PPF | |
3261 | 02/83 | Vertical Mount Cassette Holder Radiographic Systems Field Test Record | PPF | |
3297 | 04/01 | Head and Neck Radiographic Systems Field Test Record | PPF | |
3500 | 01/09 | 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 | 07/08 | Domestic Seafood (HACCP) Report | Roshelle King 301-436-1416 |
|
3502 | 07/08 | Importer Seafood HACCP Report | Roshelle King 301-436-1416 |
|
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 Steam-Air Retorts | Brian Hendrickson 317-226-6500 Ext. 104 | |
3511i | 03/06 | Processing in Other Unique Retort Systems | Brian Hendrickson 317-226-6500 Ext. 104 | |
3537 | 10/03 | Food Facility Registration {Instructions} | Melissa Scales 301-436-1720 |
|
3537a | 11/08 | Cancellation of Food Facility Registration {Instructions} | FDA Industry Systems Help Desk 800-216-7331 301-575-0156 |
|
3610 | 10/03 | Contract Audit | Beverly Kent 716-541-0331 |
|
3611 | 09/03 | Audit Report | Beverly Kent 716-541-0331 |
|
3613 | 06/06 | Supplementary Information Certificate to Foreign Government Requests |
Import/Export Team CBER 301-827-6201 or CDRH 240-276-0132 or CVM 240-276-0132 | |
3613a | 09/06 | Supplementary Information Certificate of Exportability Requests |
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 |
Import/Export Team CBER 301-827-6201 or CDER 301-827-8940 or CDRH 240-276-0132 or CVM 240-276-0132 | |
3613c | 06/06 | Supplementary Information Non-Clinical Research Use Only Certificate |
Import/Export Team CBER 301-827-6201 or CDRH 240 276-0132 | |
3613d | 02/06 | Office of Cosmetics and Colors "Certificate" Export Application |
Import/Export Team CFSAN 301-436-1130 | |
3613e | 02/06 | Food Export Certificate Application |
Import/Export Team CFSAN 301-436-2776 | |
3623 | 11/05 | Farm Investigation Questionnaire | Barbara Marcelletti 301-827-5635 |
|
3623a | 11/05 | Additional Water Sources | Barbara Marcelletti 301-827-5635 |
|
3623b | 11/05 | Additional Sets of Workers | Barbara Marcelletti 301-827-5635 |
Edition: March 24, 2009