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About FDA
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FDA Forms
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| Form | Date | Food and Drugs Administration Forms | Format | Contact Info |
|---|---|---|---|---|
| 0421 | 07/2003 | Sample Accountability Record (ORA) | (PDF - 74KB) |
At the warehouse Elizabeth.Sands@fda.hhs.gov |
| 0431 | 05/1984 | Analyst Worksheet (ORA) | (DOC - 45KB) |
At the warehouse Elizabeth.Sands@fda.hhs.gov |
| 0431a | 05/1984 | General Continuation Sheet | (PDF - 46KB) |
At the warehouse Elizabeth.Sands@fda.hhs.gov |
| 0431d | 10/1974 | Bacteriological Record | (PDF - 8KB) |
At the warehouse Elizabeth.Sands@fda.hhs.gov |
| 0431e | 03/1980 | Industrial Chemicals Worksheet | (PDF - 57KB) |
At the warehouse Elizabeth.Sands@fda.hhs.gov |
| 0431f | 11/1989 | Quantity of Contents | (PDF - 4KB) |
At the warehouse Elizabeth.Sands@fda.hhs.gov |
| 0431g | 08/1985 | Salmonella Record | (PDF - 4KB) |
William Campanaro 301-827-1036 |
| 0431h | 07/1985 | Shigella Record | (PDF - 57KB) |
At the warehouse Elizabeth.Sands@fda.hhs.gov |
| 0431i | 10/1985 | Canned Food Continuation Sheet | (PDF - 4KB) |
At the warehouse Elizabeth.Sands@fda.hhs.gov |
| 0431j | 08/1985 | Botulism Continuation Sheet | (PDF - 6KB) |
William Campanaro 301-827-1036 |
| 0431k | 08/1985 | Shellfish Bacteriological Record | (PDF - 8KB) |
William Campanaro 301-827-1036 |
| 0431m | 12/1979 | Elemental Analysis Worksheet | (PDF - 6KB) |
At the warehouse Elizabeth.Sands@fda.hhs.gov |
| 0433 | 06/1982 | Tomato Inspection Report | (PDF - 12KB) |
Norman Fogg 301-827-5645 |
| 0465 | 08/1985 | Sample Summary | (DOC - 125KB) |
At the warehouse Elizabeth.Sands@fda.hhs.gov |
| 0766 | 12/2004 | Application for Authorization to Re label or to Perform Other Action of the Federal Food, Drug, and Cosmetic Act and Other Related Acts | (PDF - 91KB) |
Domenic Veneziano 301-443-6553 |
| 1533 | 10/2001 | Results of Sediment Pad Grading | (PDF - 269KB) |
Norman Fogg 301-827-5645 |
| 1551 | 02/2006 | Report of Sample Analysis | (PDF - 332KB) |
At the warehouse Elizabeth.Sands@fda.hhs.gov |
| 1551b | 01/1993 | Report of Sample Analysis (Aflatoxins) | (PDF - 337KB) |
At the warehouse Elizabeth.Sands@fda.hhs.gov |
| 1570 | 04/1978 | Summary of Bacteriological Results | (PDF - 303KB) |
At the warehouse Elizabeth.Sands@fda.hhs.gov |
| 1570a | 04/1978 | Bacteriological Definitions | (PDF - 6KB) |
William Campanaro 301-827-1036 |
| 1609 | 03/1986 | Research Project Record | (PDF - 337KB) |
William Campanaro 301-827-1036 |
| 1609a | 03/1986 | Research Progress Record | (PDF - 349KB) |
William Campanaro 301-827-1036 |
| 2400 | 03/2001 | Cultural Procedures - General Requirements | (PDF - 105KB) |
Thomas E. Graham, Ph.D. 708-728-4114 |
| 2400a | 03/2001 | Milk Laboratory Evaluation Form: Standard Plate Count, Coliform, and Simpl | (PDF - 108KB) |
Thomas E. Graham, Ph.D. 708-728-4114 |
| 2400a-1 | 03/2001 | Milk Laboratory Evaluation Form: Spiral Plate Count Methods | (PDF - 85KB) |
Thomas E. Graham, Ph.D. 708-728-4114 |
| 2400b | 05/1987 | MLEF Detention of Inhibitory Substances in Milk | (PDF - 11KB) |
Thomas E. Graham, Ph.D. 708-728-4114 |
| 2400b-1 | 03/2001 | MLEF Detection of Inhibitory Substances in Milk Bacillus Stearothermophilus | (PDF - 92KB) |
Thomas E. Graham, Ph.D. 708-728-4114 |
| 2400b-3 | 03/2001 | MLEF Detection of Inhibitory Substances in Milk Delvotest 5 Pack | (PDF - 77KB) |
Thomas E. Graham, Ph.D. 708-728-4114 |
| 2400d | 03/2001 | MLEF Direct Microscopic Somatic Cell Count | (PDF - 71KB) |
Thomas E. Graham, Ph.D. 708-728-4114 |
| 2400h | 03/2001 | Optical Somatic Cell Count | (PDF - 78KB) |
Thomas E. Graham, Ph.D. 708-728-4114 |
| 2400h-1 | 03/2001 | MLEF Electronic Somatic Cell Count Foss 250/300/360/400 | (PDF - 67KB) |
Thomas E. Graham, Ph.D. 708-728-4114 |
| 2400h-2 | 03/2001 | MLEF Electronic Somatic Cell Count Bentley Somacount 150/300/500 | (PDF - 66KB) |
Thomas E. Graham, Ph.D. 708-728-4114 |
| 2400h-3 | 03/2001 | MLEF Electronic Somatic Cell Count Fossmatic 5000 | (PDF - 87KB) |
Thomas E. Graham, Ph.D. 708-728-4114 |
| 2400i | 03/2001 | Pasteurized Milk Containers | (PDF - 70KB) |
Thomas E. Graham, Ph.D. 708-728-4114 |
| 2400j | 03/2001 | Phosphatase Test | (PDF - 77KB) |
Thomas E. Graham, Ph.D. 708-728-4114 |
| 2400k | 03/2001 | MLEF Flat Lid Methods | (PDF - 68KB) |
Thomas E. Graham, Ph.D. 708-728-4114 |
| 2400l | 03/2001 | MLEF Disintegration Method for Paper, etc. | (PDF - 45KB) |
Thomas E. Graham, Ph.D. 708-728-4114 |
| 2400m | 03/2001 | MLEF Dairy Waters | (PDF - 88KB) |
Thomas E. Graham, Ph.D. 708-728-4114 |
| 2589 | 08/2001 | Inspection Summary - Bus Service Area Sanitation | (PDF - 16KB) |
At the warehouse Elizabeth.Sands@fda.hhs.gov |
| 2591 | 08/2001 | Inspection Summary Equipment Evaluation | (PDF - 14KB) |
Glenda Lewis 301-436-2150 |
| 2679 | 08/2001 | Food Warehouse Inspection Report | (PDF - 175KB) |
Preet Sudhaker 301-827-2908 |
| 2681 | 02/2002 | Bakery Inspection Report | (PDF - 798KB) |
Preet Sudhaker 301-827-2908 |
| 2682 | 08/2001 | Beverage Plant Inspection Report | (PDF - 20KB) |
At the warehouse Elizabeth.Sands@fda.hhs.gov |
| 2684 | 04/2002 | State Contract Monthly Food Report | (PDF - 64KB) |
Preet Sudhaker 301-827-2908 |
| 2684a | 04/2002 | State Contract Monthly Feed Establishment Report | (PDF - 70KB) |
Preet Sudhaker 301-827-2908 |
| 2782 | 09/1998 | Field Test Record Continuation Sheet | (PDF - 4KB) |
At the warehouse Elizabeth.Sands@fda.hhs.gov |
| 2783 | 10/1980 | Mobile Radiographic Systems Field Test Record | (PDF - 19KB) |
At the warehouse Elizabeth.Sands@fda.hhs.gov |
| 2784 | 05/1982 | Above Table X-Ray Source Radiographic Systems | (PDF - 30KB) |
At the warehouse Elizabeth.Sands@fda.hhs.gov |
| 2785 | 05/2002 | Dental Radiographic Systems Field Test Record | (PDF - 21KB) |
At the warehouse Elizabeth.Sands@fda.hhs.gov |
| 2786 | 05/1982 | Under Table X-Ray Source Fluoroscopic & Spot Film Systems Field Test Record | (PDF - 30KB) |
Richard Barnes 301-827-2905 |
| 2814 | 08/1993 | Field Equipment Request | (PDF - 57KB) |
William Campanaro 301-827-1086 |
| 2966 | 10/1988 | Food GMP Inspection Report | (PDF - 17KB) |
At the warehouse Elizabeth.Sands@fda.hhs.gov |
| 3068 | 08/1992 | Peak Kilovoltage Determination Field Test Record | (PDF - 57KB) |
At the warehouse Elizabeth.Sands@fda.hhs.gov |
| 3069 | 10/1980 | Above Table X-Ray Source Fluoroscopic & Spot Film Systems Field Test Record | (PDF - 19KB) |
At the warehouse Elizabeth.Sands@fda.hhs.gov |
| 3070 | 08/1992 | Mammography Systems Field Test Record | (PDF - 17KB) |
At the warehouse Elizabeth.Sands@fda.hhs.gov |
| 3071 | 04/2001 | General Information Field Test Record | (PDF - 20KB) |
At the warehouse Elizabeth.Sands@fda.hhs.gov |
| 3260 | 02/1983 | C-Arm Fluoroscopic & Spot-Film Systems Field Test Record | (PDF - 41KB) |
At the warehouse Elizabeth.Sands@fda.hhs.gov |
| 3261 | 02/1983 | Vertical Mount Cassette Holder Radiographic Systems Field Test Record | (PDF - 23KB) |
At the warehouse Elizabeth.Sands@fda.hhs.gov |
| 3297 | 04/2001 | Head and Neck Radiographic Systems Field Test Record | (PDF - 29KB) |
At the warehouse Elizabeth.Sands@fda.hhs.gov |
| 3511 | 03/2007 | FDA LACF Inspection Report | (DOC - 244KB) |
Brian Hendrickson 317-226-6500 Ext. 104 |
| 3511-2 | 03/2007 | FDA Acidified Food Inspection Report | (PDF - 589KB) |
Brian Hendrickson 317-226-6500 Ext. 104 |
| 3511-3 | 03/2007 | Aseptic Processing & Packaging Report | (DOC - 380KB) |
Brian Hendrickson 317-226-6500 Ext. 104 |
| 3511a | 03/2007 | Processing in Steam in Still Retorts | (PDF - 848KB) |
Brian Hendrickson 317-226-6500 Ext. 104 |
| 3511b | 03/2007 | Processing in Water in Still Retorts | (PDF - 836KB) |
Brian Hendrickson 317-226-6500 Ext. 104 |
| 3511c | 03/2007 | Processing in Steam in Continuous Agitating Retorts | (PDF - 893KB) |
Brian Hendrickson 317-226-6500 Ext. 104 |
| 3511d | 03/2007 | Processing in Steam in Discontinuous Agitating Retorts | (PDF - 736KB) |
Brian Hendrickson 317-226-6500 Ext. 104 |
| 3511e | 03/2007 | Processing in Water in Discontinuous Agitating Retorts | (PDF - 922KB) |
Brian Hendrickson 317-226-6500 Ext. 104 |
| 3511f | 03/2007 | Processing in Steam in Hydrostatic Retorts | (PDF - 677KB) |
Brian Hendrickson 317-226-6500 Ext. 104 |
| 3511g | 03/2007 | Processing in Cascading/Spray Water Retort | (PDF - 1000KB) |
Brian Hendrickson 317-226-6500 Ext. 104 |
| 3511h | 03/2007 | Processing in Steam-Air Retorts | (PDF - 917KB) |
Brian Hendrickson 317-226-6500 Ext. 104 |
| 3511i | 03/2006 | Processing in Other Unique Retort Systems | (PDF - 491KB) |
Brian Hendrickson 317-226-6500 Ext. 104 |
| 3610 | 10/2003 | Contract Audit | (PDF - 398KB) |
Beverly Kent 716-541-0331 |
| 3611 | 09/2003 | Audit Report | (PDF - 270KB) |
Beverly Kent 716-541-0331 |
| 3623 | 11/2005 | Farm Investigation Questionnaire | (PDF - 668KB) |
Barbara Marcelletti 301-827-5635 |
| 3623a | 11/2005 | Additional Water Sources | (PDF - 191KB) |
Barbara Marcelletti 301-827-5635 |
| 3623b | 11/2005 | Additional Sets of Workers | (PDF - 296KB) |
Barbara Marcelletti 301-827-5635 |
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