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| 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 |
| 701 | 01/89 | Customs Form 3461 "Entry/Immediate Delivery" |
|
Sammie Hadden 301-827-9632 |
| 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 | 01/06 | 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 | 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 |
| 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 | 10/03 | Food Facility Registration {Instructions} | |
Melissa Scales 301-436-1720 |
| 3537a | 10/03 | Cancellation of Food Facility Registration {Instructions} | |
Melissa Scales 301-436-1720 |
| 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 |
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Edition: April 8, 2008