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Form Date Description Format Contact Info
1815  08/2018 Certificate/ Transmittal for an Application (PDF)  (PDF - 614KB) Esther Lazar
240-402-1485
1993  08/2018 Application for Permit to Ship or Transport Milk and/or Cream into US (PDF)  (PDF - 741KB) Esther Lazar
240-402-1485
1994  01/2019 Report of Tuberculin Tests of Cattle (PDF)  (PDF - 192KB) Esther Lazar
240-402-1485
1995  08/2018 Report of Physical Examination of Cows (PDF)  (PDF - 1.1MB) Esther Lazar
240-402-1485
1996  12/2018 Farm Inspection Report (PDF)  (PDF - 3MB) Esther Lazar
240-402-1485
1997  09/2018 Score Card for Sanitation Inspections of Milk Plants (PDF)  (PDF - 672KB) Esther Lazar
240-402-1485
2359  10/2018 Milk Plant Inspection Report (PDF)  (PDF - 717KB) Frank Flores
240-402-1494
2359a  10/2011 Dairy Farm Inspection Report (PDF)  (PDF - 468KB) Frank Flores
240-402-1494
2359b  10/2011 Milk Plant Equipment Tests Report (PDF)  (PDF - 387KB) Frank Flores
240-402-1494
2359c  11/2015 Manufacturing Plant Inspection Report (PDF)  (PDF - 733KB) Frank Flores
240-402-1494
2359d  11/2015 Report of Certification (PDF)  (PDF - 708KB) Frank Flores
240-402-1494
2359e  11/2015 Status of Manufacturing Plants (PDF)  (PDF - 645KB) Frank Flores
240-402-1494
2359f  11/2015 Audit Report of IMS Listed Single-Service Containers and/or Closures for Milk and/or Milk Products Manufacturers (PDF)  (PDF - 654KB) Frank Flores
240-402-1494
2359h  10/2018 Interstate Milk Shipper Check-Rating Report (PDF)  (PDF - 1.5MB) Frank Flores
240-402-1494
2359i  10/2018 Interstate Milk Shipper Report (PDF)  (PDF - 1.6MB) Frank Flores
240-402-1494
2359j  10/2013 Milk Sanitation Rating Report (PDF)  (PDF - 738KB) Frank Flores
240-402-1494
2359k  10/2013 Status of Raw Milk for Pasteurization (PDF)  (PDF - 1.2MB) Frank Flores
240-402-1494
2359l  10/2018 Status of Milk Plants (PDF)  (PDF - 171KB) Frank Flores
240-402-1494
2359m  10/2018 Milk Plant, Receiving Station or Transfer Station NCIMS HACPP System Audit Report (PDF)  (PDF - 1.2MB) Frank Flores
240-402-1494
2359n  10/2013 NCIMS HACCP System Regulatory Agency Review Report (PDF)  (PDF - 570KB) Frank Flores
240-402-1494
2359o  10/2013 Permission for Publication Interstate Milk Shipper’s Listing (PDF)  (PDF - 659KB) Frank Flores
240-402-1494
2359p  10/2013 NCIMS Aseptic Processing and Packaging Program Critical Listing Elements (PDF)  (PDF - 649KB) Frank Flores
240-402-1494
2399  10/2008 Dairy Plant Sampling - Raw & Pasteurized Milk (PDF)  (PDF - 571KB) Frank Flores
240-402-1494
2399a  10/2011 Bulk Milk Hauler/Sampler Evaluation Report (PDF)  (PDF - 428KB) Frank Flores
240-402-1494
2399b  10/2008 Milk Tank Truck Inspection Report (PDF)  (PDF - 427KB) Frank Flores
240-402-1494
2399c  10/2011 Farm Bulk Tank Milk Sampling Inspection Record (PDF)  (PDF - 713KB) Frank Flores
240-402-1494
2399d  10/2008 Dairy Plant - Milk Sample Collector Evaluation Record (PDF)  (PDF - 457KB) Frank Flores
240-402-1494
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 - 720KB) William Northeimer, PhD
708-924-0629
2400n-1  03/2015 Milk Laboratory Evaluation Record – Appendix N Bulk Milk Tanker Screening Test Procedures – Charm® SL/Charm 3 SL3, IMS #9-C-I3 (PDF)  (PDF - 691KB) William Northeimer, PhD
708-924-0629
2400n-2  03/2014 Milk Laboratory Evaluation Record – Appendix N Bulk Milk Tanker Screening Test Procedures – New Snap® Beta-Lactam Test, IMS #9-I1 (PDF)  (PDF - 647KB) William Northeimer, PhD
708-924-0629
2541  12/2010 Food Canning Registration (HTML)  (HTM - 0KB) LACF Coordinator
301/436-2411
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  01/2018 Food Canning Registration (PDF)  (PDF - 682KB) LACF Coordinator
LACF@FDA.HHS.GOV
2541d  01/2018 Food Process Filing For Low-Acid Retorted Method (PDF)  (PDF - 1.1MB) LACF Coordinator
240-402-2411
2541e  01/2018 Food Process Filing For Acidified Method (PDF)  (PDF - 1.1MB) LACF Coordinator
240-402-2411
2541f  01/2018 Food Process Filing For Water Activity/Formulation Control Method (PDF)  (PDF - 1.1MB) LACF Coordinator
240-402-2411
2541g  01/2018 Food Process Filing For Low-Acid Aseptic Systems (PDF)  (PDF - 939KB) LACF Coordinator
240-402-2411
2591  08/2001 Inspection Summary Equipment Evaluation (PDF)  (PDF - 378KB) Bruce Kummer
240-402-2142
3038  04/2016 Interstate Shellfish Dealer's Certificate (PDF)  (PDF - 660KB) 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  03/2016 Notification for a Food Contact Substance Formulation (PDF)  (PDF - 2.6MB) Elizabeth Furukawa
650-529-9908
3480  03/2019 Notification For New Use Of A Food Contact Substance (PDF)  (PDF - 418KB) Elizabeth Furukawa
650-529-9908
3480  03/2019 Notification For New Use Of A Food Contact Substance (Instructions)  (PDF - 100KB) Elizabeth Furukawa
650-529-9908
3480a  03/2019 Amendment to an Existing Food Contact Notification Pre-Notification Consultation Food Master File (PDF)  (PDF - 172KB) Elizabeth Furukawa
650-529-9908
3480a  03/2019 Amendment to an Existing Food Contact Notification Pre-Notification Consultation Food Master File (Instructions)  (PDF - 70KB) Elizabeth Furukawa
650-529-9908
3500  10/2015 MedWatch: The FDA Safety Information and Adverse Reporting Program (PDF)  (PDF - 2.4MB) MEDWATCH
1-800-FDA-1088
3500A  10/2015 MedWatch: The FDA Safety Information and Adverse Event Reporting Program - Mandatory (PDF)  (PDF - 2.5MB) MEDWATCH
1-800-FDA-1088
3501  06/2017 Domestic Inspection/Foreign Inspection (HTML)  (HTML - 0KB) Roshelle King
240-402-1416
3502  06/2017 Importer Seafood HACCP Report (HTML)(PDF)  (HTML - 0KB) Roshelle King
240-402-1416
3503  10/2017 Food Additive Petition Submission (Instructions)  (PDF - 35KB) Berhane G. Girmay, Ph.D.
240-402-1194
3503  10/2017 Food Additive Petition Submission (PDF)  (PDF - 110KB) Berhane G. Girmay, Ph.D
240-402-1194
3537  11/2016 Food Facility Registration (PDF)  (PDF - 2.1MB) 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  08/2016 Cancellation of Food Facility Registration (PDF)  (PDF - 670KB) 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
3570  01/2011 Model Small Business Nutrition Labeling Exemption Notice (HTML)  (HTM - 0KB) SBusiness
240-402-2375
3570  10/2014 Model Small Business Nutrition Labeling Exemption Notice (PDF)  (PDF - 1.7MB) Sbusiness
240-402-2375
3613d  10/2018 Office of Cosmetics and Colors “Certificate” Export Application (HTML)  (HTM - 0KB) Export Team
3613e  10/2018 Food Export Certificate Application (HTML)  (HTM - 0KB) Export Team
3613k  10/2018 Certificate Application Process for Certification Issued Pursuant To Section 801(e) (HTML)  (HTM - 1KB) CFSAN EXPORT
3665  05/2018 Final Consultation for Food Derived From a New Plant Variety (Instructions)  (PDF - 33KB) Dr. Mary Ditto
240-402-1165
3665  05/2018 Final Consultation for Food Derived From a New Plant Variety (Biotechnology Final Consultation) (PDF)  (PDF - 97KB) Dr. Mary Ditto
240-402-1165
3666  02/2019 Early Food Safety Evaluation of a New Protein Produced by a New Plant Variety (New Protein Consultation) (PDF)  (PDF - 103KB) Berhane G. Grimay
240-402-1194
3666  02/2019 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  09/2016 Generally Recognized as Safe (GRAS) Notice (Instructions)  (PDF - 188KB) Berhane G. Grimay
240-402-1194
3667  04/2019 Generally Recognized as Safe (GRAS) Notice (PDF)  (PDF - 182KB) Berhane G. Grimay
240-402-1194
3733  05/2010 Shell Egg Producer Registration (HTML)  (HTM - 0KB) Nancy Bufano
240-402-1493
3733  08/2016 Shell Egg Producer Registration (PDF)  (PDF - 724KB) Nancy Bufano
240-402-1493
3757  06/2016 Menu and Vending Machine Labeling Voluntary Registration (PDF)  (PDF - 114KB) Ashley Rulffes
240-402-2820
3799  06/2012 Publication Request (HTML)  (PDF - 1MB) Leslie Davis
240-402-1735
3800  10/2014 FDA Safety Reporting Portal (HTML)  (HTM - 0KB) MEDWATCH
1-800-FDA-1088
3880  05/2018 Electronic Submission Gateway for New Dietary Ingredient Notification (NDIN) Submission (HTM)  (HTM - 0KB) Office of Dietary Supplement Programs
(855) 543-3784
240-402-2375
3907  03/2014 Food and Cosmetics Information Center (FCIC) Inquiry (HTML)  (HTM - 0KB) Deborah Price
240-402-1746
3942a  08/2018 Attestation by a Qualified Facility CFSAN (PDF)  (PDF - 1.1MB) Sylvia Kim
301-796-7599
3942b  08/2018 Attestation by a Qualified Facility CVM (PDF)  (PDF - 1.1MB) Sylvia Kim
301-796-7599
3955  07/2016 Structure/Function Claims Notification (HTML)  (HTM - 0KB) Mariton Dos Santos (Daniel)
240-402-2818
3958  10/2018 VNRFRPS FDA National Registry Report (PDF)  (PDF - 1.2MB) Glenda Lewis
240-402-2150
3966  10/2016 Foodborne Illness Risk Factor Study Restaurant Data Collection Record(PDF)  (PDF - 1.6MB) Mary Cartagena
240-402-2937
3967  11/2017 Risk Factor Study – Retail Food Store (Deli) Data Collection (PDF)  (PDF - 1.6MB) Mary Cartagena
240-402-2937
3972  07/2018 Dairy Labeling Module (HTML)  (HTM - 0KB) Esther Lazar
240-402-1485
3997  06/2017 FURLS Third-Party Program - Accreditation Body Module (AB) (HTML)  (HTM - 1KB) Ken Nieves
240-402-2031
3997a  06/2017 FURLS Third-Party Program - Certification Body (CB) (HTML)  (HTM - 1KB) Ken Nieves
240-402-2031

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