TTB Form 5154.1 "Formula and Process for Nonbeverage Product"

What Is TTB Form 5154.1?

This is a legal form that was released by the U.S. Department of the Treasury - Alcohol and Tobacco Tax and Trade Bureau on October 1, 2015 and used country-wide. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on October 1, 2015;
  • The latest available edition released by the U.S. Department of the Treasury - Alcohol and Tobacco Tax and Trade Bureau;
  • Easy to use and ready to print;
  • Yours to fill out and keep for your records;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of TTB Form 5154.1 by clicking the link below or browse more documents and templates provided by the U.S. Department of the Treasury - Alcohol and Tobacco Tax and Trade Bureau.

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Rate (4.4 / 5) 62 votes
OMB No. 1513-0021
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17. LABORATORY SAMPLE NUMBER
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18. ACTION
19. ALCOHOL BY VOLUME %
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20. ANALYST
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21. DATE
77% )  
TTB F 5154.1 (10/2015)
Page 1 of 2
OMB No. 1513-0021
 )2508/$ 180%(5
'(3$570(17 2) 7+( 75($685<
$/&2+2/ $1' 72%$&&2 7$; $1' 75$'( %85($8
)2508/$ $1' 352&(66 )25 121%(9(5$*( 352'8&7
 .,1' (e.g. Alcohol, Rum)
(See instructions after page 2. Prepare in triplicate except as indicated.)
3522) 63,5,76 21 :+,&+
 &+(&. ,)
 180%(5 2) '$<6
'5$:%$&. :,// %( &/$,0('
 1$0( 2) 352'8&7
6$03/( :,//
72 &203/(7(
%( 68%0,77('
352&(66
 &+(&. .,1' 2) 352'8&7
 )2508/$6 683(56('('
 1$0( 2) 0$18)$&785(5
$''5(66 :+(5( 352'8&7 :,// %(
0(',&,1(0(',&,1$/ 35(3$5$7,21
352'8&(' (If multiple production sites, list other addresses in item 22.)
)/$925)/$925,1* (;75$&7
)22' 352'8&7
3(5)80(
DIETARY SUPPLEMENT
 (/,*,%/( $%62/87( $/&2+2/ %<
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92/80( 86(' 6HH instructions)
2) ),1,6+(' 352'8&7
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% '2(6 352'8&7 &217$,1 *5($7(5 7+$1 .
$57,),&,$/ )/$925,1* ([FOXGLQJ 9DQLOOLQ (WK\O 9DQLOOLQ 0DOWRO DQG
(See instructions)
(WK\O 0DOWRO " <(6 25 12 BBBBBBBBBB
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%
 )2508/$ $1' 352&(66 (Use additional space in Box 22 if necessary)
 &217$&7 3(5621 (Include Area Code and
 6,*1$785(
7,7/( 2) $33/,&$17 25 $87+25,=(' $*(17
 '$7(
Phone No. and E-mail Address)
)25 77% 86( 21/<
17. LABORATORY SAMPLE NUMBER
 /$%25$725< 6$03/( 180%(5
18. ACTION
19. ALCOHOL BY VOLUME %
 $/&2+2/ %< 92/80(
20. ANALYST
 $1$/<67 7(
21. DATE
77% )  
TTB F 5154.1 (10/2015)
Page 1 of 2

63$&( )25 &217,18$7,21 (Please indicate item number(s) being continued.)
TTB F 5154.1 (10/2015)
3DJH  RI 
INSTRUCTIONS
A. Before filling out this form read carefully Subpart F of Part 17, Title 27,
M. ITEM 11. Answer only if recovered alcohol will be used. Add the
Code of Federal Regulations. Submit a separate formula for each
quantities, in proof gals., of all eligible spirits used (including eligible
nonbeverage product made with tax paid distilled spirits on which
spirits recovered from intermediate products) AND all ineligible
drawback is claimed (except current U.S.P., N.F., and H.P.U.S.
recovered spirits used; then divide by twice the yield of finished
preparations for which quantitative formulas are not required).
product (wine gals.), and multiply the result by 100. A range may be
stated. If the finished product is not a liquid, express as "proof gallons
B. This form must be filed within 6 months after the end of the quarter in
per batch."
which distilled spirits were first used to manufacture the product for
drawback. Submit to: Chief, Non beverage Products Laboratory,
N. ITEM 12. Answer only if product is for use in alcoholic beverages.
6000 Ammendale Road, Ammendale, MD 20705-1250. Submit in triplicate;
Definitions of "natural" and "artificial" are found in FDA regulations, 21
however, if the product will be manufactured at more than one location,
CFR 101.22. "Color additive" is defined in FDA regulations, 21 CFR
submit two additional copies for each additional location.
70.3. If the answer to question E is "No," limited or restricted ingredients
must be noted as such in item 13, including quantity used.
An alternative way to submit this form electronically can be found at
O. ITEM 13. List the name, quantity, and alcohol content, if any (by
http://www.ttb.gov/foia/fonl-main.shtml.
volume), of each ingredient used. Either metric or English measure may
C. ITEM 1. Formula numbers begin with number "1" for the first
be used. Usage of ingredients containing alcohol and the yield of liquid
submission and progress sequentially with future submissions. For
products must be expressed in wine gals. Include proof gallons of
numbering when formulas will be used at more than one plant, see
eligible spirits and recovered spirits used. Give the product name and TTB
27 CFR 17.121(c).
formula no. (from TTB Form 5154.1 or ATF F 1678) of alcoholic ingredients
if self-manufactured. If purchased, give the manufacturer's name, the name
D. ITEM 2. Include intermediate products (see 27 CFR 17.154).
of the product, and the TTB formula number, if known. Example:
E. ITEM 3. The name must reflect the type of product. For example, a
NATURAL AND ARTIFICIAL VANILLA FLAVOR:
"natural peach flavor" should contain all natural ingredients as well as
real peach. If it does not contain peach, it could be called "natural
Vanilla Extract 10 Fold
peach type flavor."
(35% alcohol, purchased from
X Company, Formula No. 102) .................. 473 ml (.125 wine gal.)
F. ITEM 4. Submission of samples is voluntary, unless specifically
required under 27 CFR 17.124. If it is known that a sample will be
Vanilla Flavor 2 Fold
submitted, either with the formula or under separate cover, please
(30% alcohol, our drawback
check the box.
Formula No. 422)............................................ 1892 ml (.5 wine gal.)
G. ITEM 5. State the number of days it takes to manufacture the product. If
it takes only a few hours to mix it, but takes an additional day to filter it,
Vanillin .......................................................................................... 30g.
that should be noted.
Alcohol - 190 proof ............................................... 946 ml (.25 wine gal.)
H. ITEM 6. State the manufacturing location. If you wish the form to be
(Eligible for drawback)
(.475 proof gal.)
returned to another address, enclose an addressed, stamped envelope.
Water Q.S. to .........................................................3785 ml (1 wine gal.)
I. ITEM 7. Indicate the type of product. Cough syrups and cold relief
products are considered medicine/medicinal preparations. Cakes and
If additional spirits may need to be added for standardization after all the
similar products are considered to be food products, while products
ingredients called for by the formula have been mixed together, please
such as lemon extracts are considered flavors. Submit commercial
so state. Identify any colors by their official FDA designations (e.g.
labels or facsimiles and any available supporting data for bitters
caramel, FD&C Yellow No. 5). Describe the manufacturing process (i.e.
(flavoring or medicinal) and for any other product that cannot be readily
simple mixture, maceration, percolation, etc.). Show the approximate
classified in the product types listed.
loss of spirits, if any, during processing (i.e. filtration, evaporation, etc.),
and indicate what quantity of alcohol, if any, is recovered. If the
J. ITEM 8. State the number(s) of any formulas to be replaced by the
manufacturing process involves separate stages, fully describe them
current submission. If formula(s) being superseded have been
and indicate the alcohol content (as a percent by volume) at the end of
approved for use at plant(s) other than the one in item 8, specify
each stage. If item 9 and/or 11 is expressed as "p.g./batch" (nonliquid
such plant(s).
products), item 13 must show the standard batch size. Formulas for
K. ITEM 9. Divide the number of proof gallons of eligible alcohol used in
preserved fruits and alcoholic candies must be accompanied by a sample.
manufacturing and standardizing the product by twice the yield of
finished product (in wine gallons). Multiply the result by 100. For
P. ITEM 15. The applicant or his/her authorized agent must sign in the space
example, if 32 proof gallons are used to make 100 gallons of product,
provided and indicate the capacity in which he/she is signing (e.g. sole
"16 %" would be entered in item 9. If the finished product is not a liquid,
proprietor, attorney-in-fact, etc.)
express as "proof gallons per batch." Eligible alcohol includes alcohol
contained in intermediate products (as defined in 27 CFR 17.11) but
Q. This form can be obtained online at http://www.ttb.gov/forms/5000.shtml
NOT alcohol contained in nonbeverage products, being used as
or by calling 1-877-882-3277 or by mail at the National Revenue Center,
ingredients, on which drawback may be claimed separately. If a range
550 Main St, Ste 8002, Cincinnati, OH 45202-5215.
include the reason(s) for variation (item 22 may be used for this)
R. An alternative way to submit this form electronically can be found at
L. ITEM 10. State the actual percentage of absolute alcohol by volume in
http://www.ttb.gov/foia/fonl-main.shtml.
the finished product. Include all alcohol, both eligible and ineligible. This
is the percentage of alcohol that would be found by analysis. If the
product is not a liquid, state the proof gals. of alcohol remaining in a
given quantity (by weight) of finished product.
PAPERWORK REDUCTION ACT NOTICE
This request is in accordance with the Paperwork Reduction Act of 1995. This form is used by TTB to determine if the product is nonbeverage in character so
that the manufacturer may file for drawback of taxes. The information is required to obtain a benefit.
The estimated burden associated with this collection of information is 30 minutes per respondent or recordkeeper, depending on individual circumstances.
Comments concerning the accuracy of this burden estimate and suggestions for reducing this burden should be addressed to the Reports Management Officer,
Regulations and Rulings Division, Alcohol and Tobacco Tax and Trade Bureau, 1310 G Street, NW., Box 12, Washington, DC 20005.
An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a current, valid OMB control
number.
TTB F 5154.1 (10/2015)
Page of 3