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pdfFORM APPROVED: OMB No. 0910-0037; EXPIRATION DATE: 02-28-2015.
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Food and Drug Administration
1. TYPE OF SUBMISSION
FOR FDA USE ONLY
FOOD CANNING ESTABLISHMENT REGISTRATION
Initial Registration
FCE No.
Date Received by FDA
Enter Current FCE: (If applicable)
Relocation (new registration required)
Change Registration Information
(See PRA statement on page 2.)
Enter Current FCE: (If applicable)
Specify Type of Change:
2. FOOD PROCESSING PLANT LOCATION
3. PREFERRED MAILING ADDRESS
Number and
Street
City and State
or Province
(or other Subdivision)
Zip (or other
Postal Code)
Number and
Street
City and State
or Province
(or other Subdivision)
Zip (or other
Postal Code)
Establishment
Name
Establishment
Name
Country (if other
than U.S.)
Telephone No.
Country (if other
than U.S.)
Telephone No.
Telefax No.
Listing products produced at this location is not a process filing.
Telefax No.
PLEASE NOTE THE FOLLOWING:
4. LOW ACID AND/OR ACIDIFIED FOODS PROCESSED AT THIS LOCATION
Food Product Name, Form or Style, and Packing Medium
(Do not list meat and poultry foods under the jurisdiction of the Food Safety and Inspection Service of the U.S.
Department of Agriculture.)
Same as Plant Location
(Check One)
Low-Acid Acidified
The requester hereby presents and acknowledges that the company is aware that in
making this request the company is subject to the terms and provisions of Title 18,
Section 1001, United States Code which makes it a criminal offense to falsify,
conceal, or cover up a material fact; make any false, fictitious, or fraudulent
statement or representation; or make or use any false writing or document knowing
the same to contain any materially false, fictitious, or fraudulent statement or entry.
Subject to the terms of 21 CFR 108.25 (c)(1) and (2) and 108.35 (c)(1) and (2), no
commercial processor shall engage in the processing of low-acid or acidified foods
until the completed forms FDA 2541 and 2541d, 2541e, 2541f or 2541g have been
filed with the FDA within the applicable time frames specified in these regulations.
Forms, Instructions, regulations, and information can be secured online at http://
www.fda.gov/Food/GuidanceRegulation/
GuidanceDocumentsRegulatoryInformation/default.htm
For more information, contact the LACF Registration Coordinator by e-mail at
[email protected]
Food and Drug Administration
LACF Registration Coordinator (HFS-303)
Center for Food Safety & Applied Nutrition
5100 Paint Branch Parkway
College Park, Maryland 20740-3835
5. ESTABLISHMENT CONTACT PERSON
Name of Contact and Business Address:
Position:
I
Owner
I
FAX Number:
FORM FDA 2541 (1/13)
n
Technologist
I
Manager
I
E-mail Address:
Director
n
PREVIOUS EDITION IS OBSOLETE
I
President/Vice President
I
Other Employee
Signature:
Page 1 of 2
I
Authorized Third Party
Phone Number:
n
Date:
PSC Publishing Services (301) 443-6740
EF
LACF Contact Information
For more information, contact the LACF Registration Coordinator by e-mail at [email protected] or phone: 240-402-2411
For paper submissions, send completed forms to:
Food and Drug Administration
LACF Registration Coordinator ((HFS-303)
Center for Food Safety and Applied Nutrition
5100 Paint Branch Parkway
College Park, MD 20740-3835
This section applies only to requirements of the Paperwork Reduction Act of 1995.
*DO NOT SEND YOUR COMPLETED FORM TO THE PRA STAFF ADDRESS BELOW.*
The burden time for this collection of information is estimated to average .17 hour per response, including the time
to review instructions, search existing data sources, gather and maintain the data needed and complete and
review the collection of information. Send comments regarding this burden estimate or any other aspect of this
information collection, including suggestions for reducing this burden, to:
Department of Health and Human Services
Food and Drug Administration
Office of Chief Information Officer
Paperwork Reduction Act (PRA) Staff
1350 Piccard Drive, Room 400
Rockville, MD 20850
“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 number.”
FORM FDA 2541 (4/12)
PREVIOUS EDITION IS OBSOLETE
Page 2 of 2
File Type | application/pdf |
File Title | FORM FDA 2541 |
Subject | , , |
Author | PSC Publishing Services |
File Modified | 2014-06-24 |
File Created | 2014-06-09 |