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U.S. Department of Health and Human Services

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FDA Forms

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Form Date Food and Drug Administration Forms Format Contact Info
1815  12/2010 Certificate/ Transmittal for an Application (PDF)  (PDF - 294KB) Esther Lazar
240-402-1485
1993  08/2009 Application for Permit to Ship or Transport Milk and/or Cream into US (PDF)  (PDF - 672KB) Esther Lazar
240-402-1485
1994  08/2009 Report of Tuberculin Tests of Cattle (PDF)  (PDF - 404KB) Esther Lazar
240-402-1485
1995  08/2009 Report of Physical Examination of Cows (PDF)  (PDF - 1.1MB) Esther Lazar
240-402-1485
1996  04/2009 Farm Inspection Report (PDF)  (PDF - 554KB) Esther Lazar
240-402-1485
1997  08/2009 Score Card for Sanitation Inspections of Milk Plants (PDF)  (PDF - 370KB) Esther Lazar
240-402-1485
2359  10/2011 Milk Plant Inspection Report (PDF)  (PDF - 449KB) Robert Hennes
240-402-2175
2359a  10/2011 Dairy Farm Inspection Report (PDF)  (PDF - 468KB) Robert Hennes
240-402-2175
2359b  10/2011 Milk Plant Equipment Tests Report (PDF)  (PDF - 387KB) Robert Hennes
240-402-2175
2359c  10/2011 Manufacturing Plant Inspection Report (PDF)  (PDF - 453KB) Robert Hennes
240-402-2175
2359d  10/2010 Report of Certification (PDF)  (PDF - 431KB) Robert Hennes
240-402-2175
2359h  10/2011 Interstate Milk Shipper Check-Rating Report (PDF)  (PDF - 589KB) Robert Hennes
240-402-2175
2359i  10/2013 Interstate Milk Shipper Report (PDF)  (PDF - 1.1MB) Robert Hennes
240-402-2175
2359j  10/2013 Milk Sanitation Rating Report (PDF)  (PDF - 738KB) Robert Hennes
240-402-2175
2359k  10/2013 Status of Raw Milk for Pasteurization (PDF)  (PDF - 1.2MB) Robert Hennes
240-402-2175
2359l  10/2011 Status of Milk Plants (PDF)  (PDF - 614KB) Robert Hennes
240-402-2175
2359m  10/2013 Milk Plant, Receiving Station or Transfer Station NCIMS HACPP System Audit Report (PDF)  (PDF - 745KB) Robert Hennes
240-402-2175
2359n  10/2013 NCIMS HACCP System Regulatory Agency Review Report (PDF)  (PDF - 570KB) Robert Hennes
240-402-2175
2359o  10/2013 Permission for Publication Interstate Milk Shipper’s Listing (PDF)  (PDF - 660KB) Robert Hennes
240-402-2175
2359p  10/2011 NCIMS Aseptic Processing and Packaging Program Critical Listing Elements (PDF)  (PDF - 387KB) Robert Hennes
240-402-2175
2399  10/2008 Dairy Plant Sampling - Raw & Pasteurized Milk (PDF)  (PDF - 571KB) Robert Hennes
240-402-2175
2399a  10/2011 Bulk Milk Hauler/Sampler Evaluation Report (PDF)  (PDF - 428KB) Robert Hennes
240-402-2175
2399b  10/2008 Milk Tank Truck Inspection Report (PDF)  (PDF - 427KB) Robert Hennes
240-402-2175
2399c  10/2011 Farm Bulk Tank Milk Sampling Inspection Record (PDF)  (PDF - 713KB) Robert Hennes
240-402-2175
2399d  10/2008 Dairy Plant - Milk Sample Collector Evaluation Record (PDF)  (PDF - 457KB) Robert Hennes
240-402-2175
2400  03/2001 Cultural Procedures - General Requirements (PDF)  (PDF - 8KB) William W. Northeimer, Ph.D.
708-924-0629
2400a  03/2001 Milk Laboratory Evaluation Form: Standard Plate Count, Coliform, and Simplified Count Methods (PDF)  (PDF - 8KB) William W. Northeimer, Ph.D.
708-924-0629
2400a-1  03/2001 Milk Laboratory Evaluation Form: Spiral Plate Count Methods (PDF)  (PDF - 85KB) William W. Northeimer, Ph.D.
708-924-0629
2400b-1  03/2001 MLEF Detection of Inhibitory Substances in Milk Bacillus Stearothermophilus (PDF)  (PDF - 8KB) William W. Northeimer, Ph.D.
708-924-0629
2400b-3  03/2001 MLEF Detection of Inhibitory Substances in Milk Delvotest 5 Pack (PDF)  (PDF - 8KB) William W. Northeimer, Ph.D.
708-924-0629
2400d  03/2001 MLEF Direct Microscopic Somatic Cell Count (PDF)  (PDF - 8KB) William W. Northeimer, Ph.D.
708-924-0629
2400h  03/2001 Optical Somatic Cell Count (PDF)  (PDF - 8KB) William W. Northeimer, Ph.D.
708-924-0629
2400h-1  03/2001 MLEF Electronic Somatic Cell Count Foss 250/300/360/400 (PDF)  (PDF - 8KB) William W. Northeimer, Ph.D.
708-924-0629
2400h-2  03/2001 MLEF Electronic Somatic Cell Count Bentley Somacount 150/300/500 (PDF)  (PDF - 8KB) William W. Northeimer, Ph.D.
708-924-0629
2400h-3  03/2001 MLEF Electronic Somatic Cell Count Fossmatic 5000 (PDF)  (PDF - 8KB) William W. Northeimer, Ph.D.
708-924-0629
2400i  03/2001 Pasteurized Milk Containers (PDF)  (PDF - 8KB) William W. Northeimer, Ph.D.
708-924-0629
2400j  03/2001 Phosphatase Test (PDF)  (PDF - 8KB) William W. Northeimer, Ph.D.
708-924-0629
2400k  03/2001 MLEF Flat Lid Methods (PDF)  (PDF - 68KB) William W. Northeimer, Ph.D.
708-924-0629
2400l  03/2001 MLEF Disintegration Method for Paper, etc. (PDF)  (PDF - 45KB) William W. Northeimer, Ph.D.
708-924-0629
2400m  03/2001 MLEF Dairy Waters (PDF)  (PDF - 8KB) William W. Northeimer, Ph.D.
708-924-0629
2400n  10/2013 Appendix N Bulk Milk Tanker Screening Procedures - General Requirements  (PDF - 699KB) William Northeimer, PhD
708-924-0629
2541  04/2012 Food Canning Registration (PDF)  (PDF - 400KB) LACF Coordinator
LACF@FDA.HHS.GOV
2541  06/2013 Food Canning Registration (Instructions-HTML)  (PDF - 1.4MB) LACF Coordinator
240-402-2411
2541  06/2013 Food Canning Registration (Instructions-PDF)  (HTML - 0KB) LACF Coordinator
LACF@FDA.HHS.GOV
2541  12/2010 Food Canning Registration (HTML)  (HTM - 0KB) LACF Coordinator
301/436-2411
2541a  04/2012 Food Process Filing For All Methods Except Low-Acid Aseptic (PDF)  (PDF - 520KB) LACF Coordinator
LACF@FDA.HHS.GOV
2541a  04/2010 Food Process Filing For All Methods Except Low-Acid Aseptic (HTML)  (HTM - 0KB) LACF Coordinator
LACF@FDA.HHS.GOV
2541c  04/2010 Food Process Filing For Low-Acid Aseptic Systems (HTML)  (HTM - 0KB) LACF Coordinator
LACF@FDA.HHS.GOV
2541c  04/2012 Food Process Filing For Low-Acid Aseptic Systems (PDF)  (PDF - 711KB) LACF Coordinator
LACF@FDA.HHS.GOV
2591  08/2001 Inspection Summary Equipment Evaluation (PDF)  (PDF - 378KB) Bruce Kummer
240-402-2142
3038  06/2013 Interstate Shellfish Dealer's Certificate (PDF)  (PDF - 656KB) Charlotte Epps
240-402-2154
3038  06/2013 Interstate Shellfish Dealer's Certificate {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} (HTML)  (HTM - 0KB) Charlotte Epps
240-402-2154
3479  09/2009 Notification for a Food Contact Substance Formulation (PDF)  (PDF - 505KB) Francis Lin
240-402-1215
3480  02/2013 Notification For New Use Of A Food Contact Substance (Instructions)  (PDF - 95KB) Francis Lin
240-402-1215
3480  02/2013 Notification For New Use Of A Food Contact Substance (PDF)  (PDF - 311KB) Francis Lin
240-402-1215
3480a  02/2013 Amendment to an Existing Food Contact Notification Pre-Notification Consultation Food Master File (PDF)  (PDF - 153KB) Francis Lin
240-402-1215
3480a  03/2013 Amendment to an Existing Food Contact Notification Pre-Notification Consultation Food Master File (Instructions)  (PDF - 64KB) Francis Lin
240-402-1215
3500  02/2013 MedWatch: The FDA Safety Information and Adverse Reporting Program (PDF)  (PDF - 1.6MB) MEDWATCH
1-800-FDA-1088
3500A  02/2013 MedWatch: The FDA Safety Information and Adverse Event Reporting Program - Mandatory (PDF)  (PDF - 1.3MB) MEDWATCH
1-800-FDA-1088
3503  08/2014 Food Additive Petition Submission (Instructions)  (PDF - 35KB) Berhane G. Girmay, Ph.D.
240-402-1194
3503  08/2014 Food Additive Petition Submission (PDF)  (PDF - 112KB) Berhane G. Girmay, Ph.D
240-402-1194
3519  07/2013 FDA National Registry Report (PDF)  (PDF - 1.2MB) Glenda Lewis
240-402-2150
3520  07/2013 Release Record and Agreement - Permission to Publish in National Registry (PDF)  (PDF - 1.2MB) Glenda Lewis
240-402-2150
3537  09/2012 Food Facility Registration (PDF)  (PDF - 1.5MB) FDA Industry Systems Help Desk
800-216-7331
301-575-0156
3537  02/2011 Food Facility Registration (HTML)  (HTM - 0KB) FDA Industry Systems Help Desk
800-216-7331
301-575-0156
3537a  08/2011 Cancellation of Food Facility Registration (PDF)  (PDF - 403KB) Industry Systems Help Desk
800-216-7331
301-575-0156
3537a  11/2008 Cancellation of Food Facility Registration (HTML)  (HTM - 0KB) FDA Industry Systems Help Desk
800-216-7331
301-575-0156
3540  05/2007 Prior Notice Submission (HTML)  (HTM - 0KB) Prior Notice Center
866-521-2297
3570  01/2011 Model Small Business Nutrition Labeling Exemption Notice (HTML)  (HTM - 0KB) SBusiness
240-402-2375
3613d  03/2012 Office of Cosmetics and Colors "Certificate" Export Application (PDF)  (PDF - 709KB) Export Team
240-402-1178
3613e  03/2012 Food Export Certificate Application (PDF)  (PDF - 454KB) Export Team
240-402-1178
3665  07/2012 Final Consultation for Food Derived From a New Plant Variety (Biotechnology Final Consultation) (PDF)  (PDF - 97KB) Dr. Mary Ditto
240-402-1165
3665  02/2012 Final Consultation for Food Derived From a New Plant Variety (Instructions)  (PDF - 28KB) Dr. Mary Ditto
240-402-1165
3666  07/2012 Early Food Safety Evaluation of a New Protein Produced by a New Plant Variety (New Protein Consultation) (PDF)  (PDF - 93KB) Berhane G. Grimay
240-402-1194
3666  07/2012 Early Food Safety Evaluation of a New Protein Produced by a New Plant Variety New Protein Consultation (Instructions)  (PDF - 32KB) Berhane G. Grimay
240-402-1194
3667  02/2013 Generally Recognized as Safe (GRAS) Notice (Instructions)  (PDF - 32KB) Berhane G. Grimay
240-402-1194
3667  02/2013 Generally Recognized as Safe (GRAS) Notice (PDF)  (PDF - 137KB) Berhane G. Grimay
240-402-1194
3733  05/2010 Shell Egg Producer Registration (HTML)  (HTM - 0KB) Nancy Bufano
240-402-1493
3733  10/2011 Shell Egg Producer Registration (PDF)  (PDF - 2.1MB) Nancy Bufano
240-402-1493
3757  07/2010 Menu and Vending Machine Labeling Voluntary Registration (PDF)  (PDF - 73KB) Felicia Billingslea
240-402-2371
3799  06/2012 Publication Request (HTML)  (HTM - 0KB) Marion Allen
240-402-1584
3800  08/2011 FDA Safety Reporting Portal (HTML)  (HTM - 0KB) Debra Street
240-402-1817
3889a  10/2013 Registration for November 21, 2013 Public Meeting (PDF)  (PDF - 1MB) Aleta Sindelar
301-502-7433
3889b  10/2013 Registration for November 25, 2013 Public Meeting (PDF)  (PDF - 1MB) Aleta Sindelar
301-502-7433
3889c  10/2013 Registration for December 6, 2013 Public Meeting (PDF)  (PDF - 1MB) Aleta Sindelar
301-502-7433
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