DEPARTMENT OF HEALTH AND HUMAN SERVICES
Food and Drug Adnxmstration
PRIOR NOTICE SUBMISSION
Form Approved: OMB No. 0910-p
Expiration Date:
I
Paperwork Reduction Act Statement
An agency may not conduct or sponsor, and a person ISnot requmzd to respond
to, a collectIon of mformation unless it displays a currently valid OMB control
number Public reporting burden for this collectlon of information ISestimated to
average 0.5-I 0 hours per response, including time for reviewng instructions,
searchmg exlstmg data sources, gathermg and maintammg the necessary data,
and completmg and rewewmg the collectlon of mformabon. Send comments
regardmg this burden estimate or any other aspect of this collectlon of
Information to the address to the right:
Food and Drug Admmlstrahon
Center for Food Safety and Apphed
Nutntlon
Office to be Determined
5100 Pamt Branch Parkway
College Park, MD 20740-3835
0 Initial a Held
Mandatory Information
o Amendment o Update
Product Identity Arrival Info
1Mandatory if applicable
0 Cancel
Submitter
First Name
Last Name
1
-4
Submitting
o U.S. Purchaser 0 U.S. Importer
o U.S. Agent of Purchaser o U.S. Agent of Importer
0 Carrier CI In-bond Carrier
Name of Firm
FDA Registration Number ci N/A #
Street Address
State
Zip

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