Form FDA 3487 FDA 3487 Notice of Final Disposition of Animals Not Intended for

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Notice of Final Disposition of
Animals Not Intended for
Immediate Slaughter

DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Food and Drug Administration
Center for Veterinary Medicine

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Form Approved: OMB No. 0910-0453
Expiration Date: 2/28/07

PAPERWORK REDUCTION ACT STATEMENT: A Federal 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. The public reporting burden for the collection of information is estimated to vary from 15 minutes to 1 hour, with an
average of 45 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the necessary information, and
completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information to the Food and
Drug Administration, Center for Veterinary Medicine, 7500 Standish Place, Rockville, MD 20855.

Submit this notice electronically to:
Food and Drug Administration
Center for Veterinary Medicine, HFV7500 Standish Place
Rockville, Maryland 20855
(E-mail:[email protected])

A1. DATE:
A2. DOCUMENT ID:
A3. STUDY / TRIAL ID:
A4. NOTICE NO:

The sponsor,
, submits a notice of final disposition of
animals treated with investigational new animal drugs and not intended for immediate slaughter as
requested by CVM authorization letter dated
. This information is submitted in electronic form.

Animals Not Intended for Immediate Slaughter:

I.
1.

NAME(S) OF THE DRUG(S)
1a. Established Name(s):

1b. Proprietary Name(s):

2.

SPECIES OF ANIMALS:

3.

METHOD OF DISPOSITION:

4.

NAME AND ADDRESS OF FACILITY WHERE ANIMALS WERE DISPOSED:

PRODUCTION CLASS:

4a. Name:
4c. Address:
4d. Address 2:
4e. City:
4g. Country:
USA
4i. Phone Number:
5.

4b. FEI #:
4f. State/Prov:
4h. Postal Code:

NUMBER OF ANIMALS:
Total:

Treated:

0

Control:

0

0

6.

APPROXIMATE DATE OF DISPOSITION:

7.

IS THIS ADDITIONAL INFORMATION FOR A NOTICE PREVIOUSLY SUBMITTED TO CVM:
YES
If Yes,

II.

NO
7a. Date Submitted to CVM:

7b. CVM Submission Identifier:

Comments:
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FORM FDA 3487 (10/2005)
Version 4.1

Page 1

III.

Sponsor Information:

1.
2a.
2b.
2c.
2e.

Name:
Address:
Address 2:
City:
Country:

3.
4.
5.
6.

Contact Name:
Contact Phone Number:
Contact Fax Number:
Contact E-Mail Address:

1a. FEI #:
2d. State/Prov:
2f. Postal Code:

USA

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FORM FDA 3487 (10/2005)
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