5020-4 Recall Distribution Information Template

Voluntary Recalls of Meat and Poultry Products

FSIS 5020-4 Recall Distribution Information Template.xlsm

OMB: 0583-0135

Document [xlsx]
Download: xlsx | pdf
OMB Number:
0583-0135
Expiration Date:
XX/XX/XX
XXXX-X
According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0583-0135. The time required to complete this information collection is estimated to average 60 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.














FSIS Recall Distribution Information Template:






Please enter consignee information in the following template. Items with (*) are required.
Either a phone number or email for each location is required (**)















Establishment number on Product Product Received by Consignee Consignee Name* Street Address Line 1* Street Address Line 2 City* State* Zip Code (5 digit)* Type of Business* (select from dropdown options) If Type of Business is "Other", enter description Distributor product was received from Amount received in pounds (numerical values only) Email** Phone Number** Comments (4,000 character limit) Contact Person First Name Contact Person Last Name Contact Person Title Contact Person Phone Contact Person Email
File Typeapplication/vnd.openxmlformats-officedocument.spreadsheetml.sheet
File Modified0000-00-00
File Created0000-00-00

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