Request for Audit Reduction 2023

OMB Number: 0910-0909 Exp Date: XX/XX/XXXX
See bottom of page 3 for PRA statement

APPENDIX I

forms pertaining to FDA awards.

REQUEST FOR AUDIT REDUCTION

1. Program Division Office:

I. CONTACT INFORMATION
2. State Liaison Contact

3. State Agency

4. State Agency Contact

II. CONTRACT INFORMATION
1. Period of Performance

Start Date:

End Date:

2. Contract Program

☐ Human Food

☐ Animal Food

3. Audit Phase

☐ Phase I

☐ Phase II

☐ Phase III

III. AUDIT REDUCTION
Please explain the reasons for requesting an audit reduction.

Please provide the number of audits planned for each type of inspection.
HUMAN FOOD
Human Food GMP

ANIMAL FOOD
PC Animal Food

LACF/AF

BSE

Seafood HACCP

Medicated Animal Food

Juice HACCP
Total

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IV. CONDITIONS OF AGREEMENT
The state and program division understand that the audit reduction is valid for the period of
performance specified in this agreement.
It is the responsibility of the program division and state to report any changes to the information provided on
the form. If the information provided on the form changes, the state shall notify the program division within
10 working days. The program division is responsible for reporting the changes to Office of Partnerships
(OP) within 10 working days. A new Request for Audit Reduction form may be needed.
V. TO BE COMPLETED BY OFFICE OF PARTNERSHIPS

☐
☐

Approved with the conditions set forth in this agreement
Not approved for the following reasons:

OP Approving Official

Date

Distribution
Director, Office of Partnerships
Program Division Director
Project Manager, OP
State Liaison/District Technical Advisor
State Agency

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Appendix I
Instructions for Completing the Request for Audit Reduction
AUDIT REDUCTIONS MUST BE REQUESTED DURING THE FIRST QUARTER OF THE CONTRACT
PERIOD OF PERFORMANCE OR AT THE TIME THE PROGRAM BECOMES AWARE OF THE NEED FOR
A REDUCTION.
GENERAL
Use this form to obtain approval for reducing the required number of audits for the human and animal food
contract inspection programs. The Program Division will complete and submit the form to the OP Audit
Program Manager. If an audit reduction is needed in both feed and food, the Program Division must complete
and submit separate forms for each program.
The OP Audit Program Manager will provide copies to the Program Division Director, OP Project Manager,
State Liaison/District Technical Advisor, and the State Agency as notification of approval or disapproval of the
request.
The request for audit reduction must be submitted and approved for each 12-month period of performance.
SPECIFIC
I. Contact Information

1. Provide the Program Division.
2. Provide the name of the Program Division person to be contacted for the information.
3. Provide the State Agency.
4. Provide the name of the State person to be contacted for the information.
II. Contract Information

1. Period of Performance (MM/DD/YYYY) - Enter the start date and end date of the contract period.
2. Select the box for the contract inspection program. When requesting a reduction in audits for the food
contract program, check Human Food. When requesting a reduction in audits for the animal food
contract program, check Animal Food.

3. Check the state’s phase of implementation of the contract audit program.
III. Audit Reduction

1. Briefly explain the reasons for requesting an audit reduction.
2. Provide the number of audits planned for each type of inspection.
IV. Conditions of Agreement
The Program Division and state shall read and understand these conditions of agreement. It is the
responsibility of the Program Division and state to report any changes to the information provided on the
form. If the information provided on the form changes, the state shall notify the Program Division within
10 working days. The Program Division is responsible for reporting the changes to OP Audit Program
Manager within 10 working days. A new Request for Audit Reduction Form may be needed.
V. To Be Completed By OP
This section is for OP only and should be left blank. If the audit reduction is not approved, an
explanation will be provided.

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