Form 2512a Cosmetic Product Ingredient

Voluntary Cosmetic Registration Program

Form FDA 2512a

Reporting (21 CFR 720.6) Voluntary Registration (Amendments)

OMB: 0910-0027

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DEPARTMENT OF HEALTH AND HUMAN SERVICES
FOOD AND DRUG ADMINISTRATION
COLLEGE PARK, MD 20740-3835

Form Approved: OMB N0. 0910-0030.

TYPE OF SUBMISSION:

COSMETIC PRODUCT INGREDIENT STATEMENT
(In accordance with 21 CFR 720)
Read Instruction Booklet Before Completing. Type entries in CAPITAL LETTERS.

Expiration Date: February 29, 2012.
See Burden Statement on Reverse of Part I.

ORIGINAL

AMENDED

FOR FDA USE ONLY ON ORIGINAL SUBMISSIONS
FDA CPIS NO.

FILING DATE

F

NOTE: This report is authorized by Public Law 21 U.S.C. 371(a); 21 CFR 720. While you are not required to respond, your cooperation is needed to make the results of this
voluntary program comprehensive, accurate, and timely.
INGRED NO.

1. COMMON, USUAL, OR CHEMICAL NAME
3. TYPE OF ACTION

2. 9 - DIGIT CAS NO.

01

6. BASE CPIS NO.

F

B

7. BASE NAME OR TRADE NAME MATERIAL

4. DATE OF ACTION

5. CONF

8. COMPANY NAME

1. COMMON, USUAL, OR CHEMICAL NAME

02

2. 9 - DIGIT CAS NO.
6. BASE CPIS NO.

F

3. TYPE OF ACTION

B

7. BASE NAME OR TRADE NAME MATERIAL

4. DATE OF ACTION

5. CONF

8. COMPANY NAME

1. COMMON, USUAL, OR CHEMICAL NAME

03

2. 9 - DIGIT CAS NO.
6. BASE CPIS NO.

F

3. TYPE OF ACTION

B

7. BASE NAME OR TRADE NAME MATERIAL

4. DATE OF ACTION

5. CONF

8. COMPANY NAME

1. COMMON, USUAL, OR CHEMICAL NAME

04

2. 9 - DIGIT CAS NO.
6. BASE CPIS NO.

F

3. TYPE OF ACTION

B

7. BASE NAME OR TRADE NAME MATERIAL

4. DATE OF ACTION

5. CONF

8. COMPANY NAME

1. COMMON, USUAL, OR CHEMICAL NAME

05

2. 9 - DIGIT CAS NO.
6. BASE CPIS NO.

F

3. TYPE OF ACTION

B

7. BASE NAME OR TRADE NAME MATERIAL

4. DATE OF ACTION

5. CONF

8. COMPANY NAME

1. COMMON, USUAL, OR CHEMICAL NAME

06

2. 9 - DIGIT CAS NO.
6. BASE CPIS NO.

F

3. TYPE OF ACTION

B

7. BASE NAME OR TRADE NAME MATERIAL

4. DATE OF ACTION

5. CONF

8. COMPANY NAME

1. COMMON, USUAL, OR CHEMICAL NAME

07

2. 9 - DIGIT CAS NO.
6. BASE CPIS NO.

F

3. TYPE OF ACTION

B

7. BASE NAME OR TRADE NAME MATERIAL

4. DATE OF ACTION

5. CONF

8. COMPANY NAME

1. COMMON, USUAL, OR CHEMICAL NAME

08

2. 9 - DIGIT CAS NO.
6. BASE CPIS NO.

F

3. TYPE OF ACTION

B

7. BASE NAME OR TRADE NAME MATERIAL

4. DATE OF ACTION

5. CONF

8. COMPANY NAME

1. COMMON, USUAL, OR CHEMICAL NAME

09

2. 9 - DIGIT CAS NO.
6. BASE CPIS NO.

F

3. TYPE OF ACTION

B

7. BASE NAME OR TRADE NAME MATERIAL

4. DATE OF ACTION

5. CONF

8. COMPANY NAME

1. COMMON, USUAL, OR CHEMICAL NAME

10

3. TYPE OF ACTION

2. 9 - DIGIT CAS NO.
6. BASE CPIS NO.

F

FORM FDA 2512a (6/09)

B

7. BASE NAME OR TRADE NAME MATERIAL

Previous Edition is Obsolete.

4. DATE OF ACTION

5. CONF

8. COMPANY NAME

This Form Must be Securely Attached to Form FDA 2512.

PSC Graphics: (301) 443-1090

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of

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Public reporting burden for this collection of information is estimated to average 10 minutes per response, including the time for reviewing
instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of
information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing
this burden to:
Department of Health and Human Services
Food and Drug Administration
Office of Chief Information Officer (HFA-710)
5600 Fishers Lane
Rockville, MD 20857

FORM FDA 2512a (6/09) (BACK)

An agency may not conduct or sponsor, and a person is not required to respond to, a
collection of information unless it displays a currently valid OMB control number.


File Typeapplication/pdf
File TitleFORM FDA 2512a
SubjectCosmetic Product Ingredient Statement
AuthorPSC Graphics
File Modified2011-02-25
File Created2009-06-18

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