Form TTB F 5154.1 TTB F 5154.1 Formula and Proces for Non Beverage Product

 OMB No. 1513-0021(07/31/2008)

1. FORMULA NUMBER

DEPARTMENT OF THE TREASURY
ALCOHOL AND TOBACCO TAX AND TRADE BUREAU

FORMULA AND PROCESS FOR NON BEVERAGE PRODUCT
(See instructions after page 2. Prepare in triplicate except as indicated.)
4. CHECK IF
SAMPLE WILL
BE SUBMITTED

3. NAME OF PRODUCT

6. NAME OF MANUFACTURER & ADDRESS WHERE PRODUCT WILL BE
PRODUCED (If multiple production sites, list other addresses in item 22.)

2. KIND (e.g. Alcohol, Rum) &
PROOF SPIRITS ON WHICH
5. NUMBER OF DAYS
DRAWBACK WILL BE CLAIMED
TO COMPLETE
PROCESS

7. CHECK KIND OF PRODUCT
MEDICINE/MEDICINAL PREPARATION
FLAVOR/FLAVORING EXTRACT
FOOD PRODUCT
PERFUME
DIETARY SUPPLEMENT

8. FORMULAS SUPERSEDED

9. ELIGIBLE ABSOLUTE ALCOHOL BY
VOLUME USED (See instructions)

10. ALCOHOL CONTENT BY VOLUME
OF FINISHED PRODUCT

%

%

11. IF MADE WITH RECOVERED SPIRITS 12. IF FINISHED PRODUCT IS TO BE USED IN ALCOHOLIC BEVERAGES:
ELIGIBLE PLUS RECOVERED ABSOA. DOES PRODUCT CONTAIN NATURAL FLAVORING? (YES OR NO)____________
LUTE ALCOHOL BY VOLUME USED.
B. DOES PRODUCT CONTAIN GREATER THAN 01% ARTIFICIAL FLAVORING (Excluding Vanillin, Ethyl Vanillin, Maltol, and
(See instructions)
Ethyl Maltol)? (YES OR NO)__________
C. STATE PARTS PER MILLION IN PRODUCT OF: SYNTHETIC VANILLIN _________ ETHYL VANILLIN ________
SYNTHETIC MALTOL __________ ETHYL MALTOL____________
D. DOES PRODUCT CONTAIN ANY COLOR ADDITIVE?__________IF YES, WHICH?_________
E. ARE ALL INGREDIENTS APPROVED BY FDA FOR USE WITHOUT LIMITATION OR RESTRICTION? (YES OR NO)______
%

13. FORMULA AND PROCESS (Use additional space in Box 22 if necessary)

14. CONTACT PERSON (Include Area Code DQG
Phone No.DQG(PDLO$GGUHVV)

15. SIGNATURE & TITLE OF APPLICANT OR AUTHORIZED AGENT

FOR TTB USE ONLY
17.
NUMBER
17. LABORATORY
LABORATORYSAMPLE
SAMPLE
NUMBER

18. ACTION

19. ALCOHOL
ALCOHOLBY
BYVOLUME
VOLUME %
19.
%

20.
ANALYST2TE
20. ANALYST

21. FDATE
TTB
5154.1 (6/2006)

TTB F 5154.1 (07/2008)

Page 1 of 2

16. DATE

22.

SPACE FOR CONTINUATION (Please indicate item number(s) being continued.)

Page 2 of 2

TTB F 5154.1 /200

INSTRUCTIONS
A. Before filling out this form read carefully Subpart F of Part 17, Title 27,
Code of Federal Regulations. Submit a separate formula for each
nonbeverage product made with tax paid distilled spirits on which
drawback is claimed (except current U.S.P., N.F, and H.P.U.S.
preparations for which quantitative formulas are not required).
B. This form must be filed within 6 months after the end of the quarter in
which distilled spirits were first used to manufacture the product for
drawback. Submit to: Chief, Non beverage Products Laboratory,
6000 Ammendale Road, $PPHQGDOH, MD 20705. Submit in triplicate;
however, if the product will be manufactured at more than one location,
submit two additional copies for each additional location.
C. ITEM 1. Formula numbers begin with number “1” for the first
submission and progress sequentially with future submissions. For
numbering when formulas will be used at more than one plant,
see 27 CFR 17.121(c).
D. ITEM 2. Include intermediate products (see 27 CFR 17.154).
E. ITEM 3. The name must reflect the type of product. For example, a
“natural peach flavor” should contain all natural ingredients as well as
real peach. If it does not contain peach, it could be called “natural
peach type flavor.”

M. ITEM 11. Answer only if recovered alcohol will be used. Add the
quantities, in proof gals., of all eligible spirits used (including eligible
spirits recovered from intermediate products) AND all ineligible
recovered spirits used; then divide by twice the yield of finished
product (wine gals.), and multiply the result by 100. A range may be
stated. If the finished product is not a liquid, express as “proof gallons
per batch.”
N. ITEM 12. Answer only if product is for use in alcoholic beverages.
Definitions of “natural” and “artificial” are found in FDA regulations, 21
CFR 101.22. “Color additive” is defined in FDA regulations, 21 CFR
70.3. If the answer to question E is “No,” limited or restricted ingredients
must be noted as such in item 13, including quantity used.
O. ITEM 13. List the name, quantity, and alcohol content, if any (by
volume), of each ingredient used. Either metric or English measure may
be used. Usage of ingredients containing alcohol and the yield of liquid
products must be expressed in wine gals. Include proof gallons of
eligible spirits and recovered spirits used. Give the product name and TTB
formula no. (from TTB Form 5154.1 or $7))1678) of alcoholic ingredients
if self-manufactured. If purchased, give the manufacturer’s name, the
name of the product, and the TTB formula number, if known. Example:

NATURAL AND ARTIFICIAL VANILLA FLAVOR:
F. ITEM 4. Submission of samples is voluntary, unless specifically
required under 27 CFR 17.124. If it is known that a sample will be
submitted, either with the formula or under separate cover, please
check the box.

Vanilla Extract 10 Fold
(35% alcohol, purchased from
X Company, Formula No. 102) .................. 473 ml (.125 wine gal.)

G. ITEM 5. State the number of days it takes to manufacture the product. If
it takes only a few hours to mix it, but takes an additional day to filter it,
that should be noted.

Vanilla Flavor 2 Fold
(30% alcohol, our drawback
Formula No. 422)............................................1892 ml (.5 wine gal.)

H. ITEM 6. State the manufacturing location. If you wish the form to be
returned to another address, enclose an addressed, stamped envelope.

Vanillin .......................................................................................... 30g.

I.

Alcohol - 190 proof ............................................... 946 ml (.25 wine gal
(Eligible for drawback)
(.475 proof gal.)

ITEM 7. Indicate the type of product. Cough syrups and cold relief
products are considered medicine/medicinal preparations. Cakes and
similar products are considered to be food products, while products
such as lemon extracts are considered flavors. Submit commercial
labels or facsimiles and any available supporting data for bitters
(flavoring or medicinal) and for any other product that cannot be readily
classified in the product types listed.

J. ITEM 8. State the number(s) of any formulas to be replaced by the
current submission. If formula(s) being superseded have been
approved for use at plant(s) other than the one in item 8, specify
such plant(s).
K. ITEM 9 Divide the number of proof gallons of eligible alcohol used in
manufacturing and standardizing the product by twice the yield of
finished product (in wine gallons). Multiply the result by 100. For
example, if 32 proof gallons are used to make 100 gallons of product,
“16 %“ would be entered in item 9. If the finished product is not a liquid,
express as “proof gallons per batch.” Eligible alcohol includes alcohol
contained in intermediate products (as defined in 27 CFR 17.11) but
NOT alcohol contained in nonbeverage products, being used as
ingredients, on which drawback may be claimed separately. If a range
is stated, include the reason(s) for variation (item 22 may be used
for this).
L. ITEM 10. State the actual percentage of absolute alcohol by volume in
the finished product. Include all alcohol, both eligible and ineligible.
This is the percentage of alcohol that would be found by analysis. If the
product is not a liquid, state the proof gals. of alcohol remaining in a
given quantity (by weight) of finished product.

Water Q.S. to .........................................................3785ml (1wine gal.)
If additional spirits may need to be added for standardization after all the
ingredients called for by the formula have been mixed together, please
so state. Identify any colors by their official FDA designations (e.g.
caramel, FD&C Yellow No. 5). Describe the manufacturing process (i.e.
simple mixture, maceration, percolation, etc.). Show the approximate
loss of spirits, if any, during processing (i.e. filtration, evaporation, etc.),
and indicate what quantity of alcohol, if any, is recovered. If the
manufacturing process involves separate stages, fully describe them
and indicate the alcohol content (as a percent by volume) at the end of
each stage. If item 9 and/or 11 is expressed as “p.g./batch” (nonliquid
products), item 13 must show the standard batch size. Formulas for
preserved fruits and alcoholic candies must be accompanied by a sample.
P. ITEM 15. The applicant or hisKHU authorized agent must sign in the space
provided and indicate the capacity in which heVKH is signing (e.g. sole
proprietor, attorney-in-fact, etc.)
Q. This form can be obtained online at http://www.ttb.gov/forms/5000.shtml
or by calling 1-877-882-3277 or by mail at the National Revenue Center,
550 Main St, Ste 8002, Cincinnati, OH 45202-5215.

PAPERWORK REDUCTION ACT NOTICE
This request is in accordance with the Paperwork Reduction Act of 1995. This form is used by TTB to determine if the product is nonbeverage in character so
that the manufacturer may file for drawback of taxes. The information is required to obtain a benefit.
The estimated burden associated with this collection of information is 30 minutes per respondent or recordkeeper, depending on individual circumstances.
Comments concerning the accuracy of this burden estimate and suggestions for reducing this burden should be addressed to WKHReports Management Officer,
Regulations and Rulings Division, Alcohol and Tobacco Tax and Trade Bureau, Washington, DC 20220.
An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a current valid OMB control
number.

TTB F 5154.1 (07/2008)