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Form Date Description Format Contact Info
2786  05/1982 Under Table X-Ray Source Fluoroscopic & Spot Film Systems Field Test Record (PDF)  (PDF - 30KB) Nick Walker
301-796-5910
2814  08/1993 Field Equipment Request (PDF)  (PDF - 1.1MB) William Campanaro
301-827-1086
2830  05/2015 Blood Establishment Registration and Product Listing (PDF)  (PDF - 767KB) bloodregis@fda.hhs.gov
2877  08/2014 Declaration for Imported Electronic Products Subject to Radiation Control Standards (PDF)  (PDF - 670KB) DRH
301-796-5790
2914  10/2014 Radioactive Drug Research Committee (RDRC) Report on Research Use of Radioactive Drugs Membership Summary (PDF)  (PDF - 3.3MB) RDRC
301-796-2050
2915  10/2014 Radioactive Drug Research Committee (RDRC) Report on Research Use of Radioactive Drugs Study Summary (PDF)  (PDF - 1.9MB) RDRC
301-796-2050
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
3068  08/1992 Peak Kilovoltage Determination Field Test Record (PDF)  (PDF - 57KB) Nick Walker
301-796-5910
3069  10/1980 Above Table X-Ray Source Fluoroscopic & Spot Film Systems Field Test Record (PDF)  (PDF - 19KB) Nick Walker
301-796-5910
3071  04/2001 General Information Field Test Record (PDF)  (PDF - 20KB) Nick Walker
301-796-5910
3131  08/2001 Contract Property Administration Completion Report (PDF)  (PDF - 5KB) Mike McGrath
301-827-7105
3147  04/2011 Application for a Variance From 21 CFR 1040.11(c) for a Laser Light Show, Display, or Device (HTML)  (HTM - 0KB) DRH
301-796-5790
3147  08/2016 Application for a Variance From 21 CFR 1040.11(c) for a Laser Light Show, Display, or Device (PDF)  (PDF - 715KB) DRH
301-796-5790
3260  02/1983 C-Arm Fluoroscopic & Spot-Film Systems Field Test Record (PDF)  (PDF - 41KB) Nick Walker
301-796-5910
3261  02/1983 Vertical Mount Cassette Holder Radiographic Systems Field Test Record (PDF)  (PDF - 23KB) Nick Walker
301-796-5910
3297  04/1984 Head and Neck Radiographic Systems Field Test Record (PDF)  (PDF - 29KB) Nick Walker
301-796-5910
3316  08/1985 DRUG MASTER FILE REVIEW BINDER-Red  (HTML - 14KB) CDER Drug Info at 301-796-3400
3316a  08/1985 DRUG MASTER FILE ARCHIVAL BINDER-Blue  (HTML - 14KB) CDER Drug Info at 301-796-3400
3331a  05/2017 NDA/ANDA Field Alert Report Automated (Instructions)  (PDF - 143KB) Surveillance Programs Team
301-796-3130
3331a  07/2016 NDA/ANDA Field Alert Automated(PDF)  (PDF - 2.6MB) Surveillance Programs Team
301-796-3130
3356  01/2011 Establishment Registration and Listing for Human Cells, Tissues, and Cellular and Tissue-Based Products (HCT/Ps) (HTML)  (HTM - 0KB) tissuereg@fda.hhs.gov
3356  05/2014 Establishment Registration and Listing for Human Cells, Tissues, and Cellular and Tissue-Based Products (HCT/Ps) (PDF)  (PDF - 922KB) tissuereg@fda.hhs.gov
3397  03/2016 PDUFA User Fee Cover Sheet (HTML)  (HTM - 0KB) CDER Collections at 301.796.7900
3410  10/2001 Confidential Financial Disclosure Report (PDF)  (PDF - 492KB) Vincent Tolino
301-827-5514
3419  07/2016 Medical Device Reporting Annual User Facility Report (PDF)  (PDF - 701KB) OSB/CDRH/RSMB
301-796-6104
3422  11/2016 Government Entity Declaration (PDF)  (PDF - 727KB) Denise Robinson
301-796-5919
3427  10/2015 Supplemental Data Sheet (PDF)  (PDF - 692KB) Marjorie Shulman
301-796-6572
3429  10/2015 General Device Classification Questionnaire (PDF)  (PDF - 718KB) Marjorie Shulman
301-796-6572
3448  05/2017 Medicated Feed Mill License Application (PDF)  (PDF - 569KB) Isabel W. Pocurull
240-402-5877

Page Last Updated: 06/26/2017
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