Form Approved: OMB No. 0910-0337, Expiration Date: June 30, 2025. See PRA Statement on Reverse.
DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration
MEDICATED FEED MILL LICENSE APPLICATION |
FOR FDA USE ONLY ![]() APPROVAL DATE:
SIGNED BY:
(For the Commissioner of Food and Drugs)
LICENSE NUMBER ISSUED: |
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MANUFACTURING SITE LEGAL BUSINESS NAME:
ADDRESS: (Street, City, State and Zip code)
PHONE NUMBER: EXT.: FAX NUMBER: EMAIL ADDRESS: |
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FDA DRUG ESTABLISHMENT No. (enter DUNS No.): |
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FACILITY ESTABLISHMENT IDENTIFIER (FEI) No.: |
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MAILING ADDRESS/PHONE NUMBERS (If different from above)
PHONE NUMBER: EXT.: FAX NUMBER: EMAIL ADDRESS: |
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TYPE OF APPLICATION:
![]() Original
![]() Supplemental: License No. - |
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As a Medicated Feed Mill Licensee, you have certified that:
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As a Medicated Feed Mill Licensee, you have committed to:
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EMAIL
TO (via attachment): [email protected]
or
MAIL
TO:
U.S.
Food
and
Drug
Administration,
CVM,
Division
of
Food
Compliance
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I CERTIFY that all of the statements made in this application are true and complete to the best of my knowledge and ability. WARNING: A willfully false certification is a criminal offense. U.S. Code, Title 18, Sec. 1001. |
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NAME OF RESPONSIBLE INDIVIDUAL FOR THIS MANUFACTURING SITE (printed or typed): |
TITLE OF MOST RESPONSIBLE INDIVIDUAL (printed or typed): |
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SIGNATURE OF RESPONSIBLE INDIVIDUAL: (application must be signed and dated) |
DATE: |
FORM FDA 3448 (1/23) PSC Publishing Services (301) 443-6740 EF
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FORM FDA 3448 (1/23)
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
Author | Bean, Domini |
File Modified | 0000-00-00 |
File Created | 2024-07-29 |