Notification, Documentation, and Recordkeeping

Requirements to Notify FSIS of Adulterated or Misbranded Products, Prepare and Maintain Written Recall Procedures, and Document Certain HACCP Plan Reassessments

Documents and Forms

Document Name Document Type
Form 5720-16 Notification, Documentation, and Recordkeeping Form
PHIS screenshot for 0583-0144 electronic data collection report of adulteration or misbranding.docx Other-screenshot for electronic repo
1 - Notifier Page.JPG Other-PHIS APM
2 - Establishments Page.JPG Other-PHIS APM
3-1 - Product Page top.JPG Other-PHIS APM
3-2 -Product Page bottom.JPG Other-PHIS APM
3-3 - Product Page (Issues)JPG.JPG Other-PHIS APM
4 - Attachments Page.JPG Other-PHIS APM
5 - Summary Page (no data entry).JPG Other-PHIS APM
Wizard 1 - Notifier .JPG Other-PHIS APM
5720-16 Industry Report of Adulteration FSIS 5720-16 Industry Report of Adulteration.pdf Form

Information Collection (IC) Details

IC Title:	Notification, Documentation, and Recordkeeping	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 9 CFR 418.2 9 CFR 417.4(a) 9 CFR 418.3

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	5720-16	Industry Report of Adulteration	FSIS 5720-16 Industry Report of Adulteration.pdf	Yes	Yes	Fillable Fileable
Other-screenshot for electronic reporting through PHIS			PHIS screenshot for 0583-0144 electronic data collection report of adulteration or misbranding.docx	Yes	Yes	Fillable Fileable
Other-PHIS APM			1 - Notifier Page.JPG	Yes	Yes	Fillable Fileable
Other-PHIS APM			2 - Establishments Page.JPG	Yes	Yes	Fillable Fileable
Other-PHIS APM			3-1 - Product Page top.JPG	Yes	Yes	Fillable Fileable
Other-PHIS APM			3-2 -Product Page bottom.JPG	Yes	Yes	Fillable Fileable
Other-PHIS APM			3-3 - Product Page (Issues)JPG.JPG	Yes	Yes	Fillable Fileable
Other-PHIS APM			4 - Attachments Page.JPG	Yes	Yes	Fillable Fileable
Other-PHIS APM			5 - Summary Page (no data entry).JPG	Yes	Yes	Fillable Fileable
Other-PHIS APM			Wizard 1 - Notifier .JPG	Yes	Yes	Fillable Fileable

Line of Business: Environmental Management

Subfunction: Environmental Monitoring and Forecasting

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 6,300	Number of Respondents for Small Entity: 2,900

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 80 %

	Requested	Previously Approved
Annual Number of Responses for this IC	42,900	42,900
Annual IC Time Burden (Hours)	9,960	9,960
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.