FDA FOOD FACILITY REGISTRATION

《FDA FOOD FACILITY REGISTRATION》由会员上传分享，免费在线阅读，更多相关内容在学术论文-天天文库。

1、FormApproval:OMBNo.0910-0502;ExpirationDate:03/31/2013;SeePRAStatementonpage10.FDAUSEONLYDEPARTMENTOFHEALTHANDHUMANSERVICESFoodandDrugAdministrationDHHS/FDAFOODFACILITYREGISTRATION(Ifenteringbyhand,useblueorblackinkonly.)Date(mm/dd/yyyy)Section1–TYPEOFREGISTRATION1a.DOMESTICRE

2、GISTRATIONFOREIGNREGISTRATION1b.INITIALREGISTRATIONUPDATEOFREGISTRATIONINFORMATION1c.BIENNIALREGISTRATIONRENEWALFacilityRegistrationNumberPINIfupdateorbiennialregistrationrenewal,providetheFacilityRegistrationNumberandPINForupdateofregistrationinformation:CheckallthatapplyUnit

3、edStatesAgentChange-ForeignfacilitiesonlyandfurtheridentifychangesintheapplicablesectionsFacilityNameChangeSeasonalFacilityDatesofOperationChangeFacilityAddressChange(Seeinstructions)TypeofActivityChangePreferredMailingAddressChangeTypeofStorageChangeParentCompanyChangeHumanFo

4、odProductCategoryChangeEmergencyContactChangeAnimalFoodProductCategoryChangeTradeNameChangeOperatororAgentinChargeChangeAREYOUTHENEWOWNEROFAPREVIOUSLYREGISTEREDFACILITY?YesNo1d.If“Yes”,providethefollowinginformation,ifknown.Previousowner’snamePreviousowner’sregistrationnumberS

5、ection2–FACILITYNAME/ADDRESSINFORMATIONFacilityNameFacilityStreetAddress,Line1FacilityStreetAddress,Line2CityState(Ifapplicable;ifnot,skiptoProvince/Territory)Province/Territory(Ifapplicable)ZIPorPostalCodeCountryPhoneNumber(IncludeArea/CountryCode)FAXNumber(Optional;IncludeAr

6、ea/CountryCode)E-MailAddressFORMFDA3537(9/12)Page1of10PSCPublishingServices(301)443-6740EFDHHS/FDAFOODFACILITYREGISTRATIONSection3–PREFERREDMAILINGADDRESSINFORMATION-CompletethissectiononlyifdifferentfromSection2FacilityName/AddressInformation(OPTIONAL)NameStreetAddress,Line1S

7、treetAddress,Line2CityState(Ifapplicable;ifnot,skiptoProvince/Territory)Province/Territory(Ifapplicable)ZIPorPostalCodeCountryPhoneNumber(IncludeArea/CountryCode)FAXNumber(Optional;IncludeArea/CountryCode)E-MailAddress(Optional)Section4–PARENTCOMPANYNAME/ADDRESSINFORMATION(Ifa

8、pplicableandifdifferentfromSections2and3)Ifinformationisthesa