FSIS Form 8822-4 Request for Label Reconsideration

Form 8822-4 or the "Request For Label Reconsideration" is a form issued by the U.S. Department of Agriculture - Food Safety and Inspection Service.

Download a fillable PDF version of the Form 8822-4 down below or find it on the U.S. Department of Agriculture - Food Safety and Inspection Service Forms website.

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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 0583-0092. The time required to complete this information collection is
estimated to average 2 hours 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.
U.S. DEPARTMENT OF AGRICULTURE
DATE
FOOD SAFETY AND INSPECTION SERVICE
REQUEST FOR LABEL RECONSIDERATION
APPROVAL FOR
PRODUCT NAME
SKETCH
FIRM NAME, ADDRESS, TELEPHONE NUMBER
TEMPORARY
ESTABLISHMENT NUMBER /
FOREIGN COUNTRY
BARCODE AND/OR APPROVAL NUMBER
COMPANY REASON(S) FOR REQUESTING LABEL RECONSIDERATION
SEE CONTINUATION SHEET
REVIEWER'S REASON FOR DISAPPROVAL OR MODIFICATION
DATE
REVIEWER'S INITIALS
SIGNATURE OF APPLICANT OR AGENT
DATE
FSIS FORM 8822-4 (11/16/2011)
PREVIOUS EDITIONS ARE OBSOLETE.
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 0583-0092. The time required to complete this information collection is
estimated to average 2 hours 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.
U.S. DEPARTMENT OF AGRICULTURE
DATE
FOOD SAFETY AND INSPECTION SERVICE
REQUEST FOR LABEL RECONSIDERATION
APPROVAL FOR
PRODUCT NAME
SKETCH
FIRM NAME, ADDRESS, TELEPHONE NUMBER
TEMPORARY
ESTABLISHMENT NUMBER /
FOREIGN COUNTRY
BARCODE AND/OR APPROVAL NUMBER
COMPANY REASON(S) FOR REQUESTING LABEL RECONSIDERATION
SEE CONTINUATION SHEET
REVIEWER'S REASON FOR DISAPPROVAL OR MODIFICATION
DATE
REVIEWER'S INITIALS
SIGNATURE OF APPLICANT OR AGENT
DATE
FSIS FORM 8822-4 (11/16/2011)
PREVIOUS EDITIONS ARE OBSOLETE.
FSIS FORM 8822-4 (11/16/2011) page 2
FOR USDA USE ONLY
DIRECTOR, LABELING AND PROGRAM DELIVERY DIVISION
Concurrence w/Reviewer
SIGNATURE
DATE
Nonconcurrence w/Reviewer
(Explain below)
COMMENTS
Appeals focus on labeling and standards policy issues. The issue(s) addressed on this appeal is/are the one(s) identified by the company in the space
provided for the reviewer's reasons for disapproval or modification. The label/application has not been evaluated for compliance with other labeling and
standards regulations or policies, or for other issues. Submission of the label/application for evaluation in the normal review process may yield
additional problems that require correction. We suggest that prior to submitting any label, careful consideration be made with regard to conformance
with FSIS regulations and policies.
ASSISTANT ADMINISTRATOR, OPPD
SIGNATURE
DATE
Concurrence w/Director
Nonconcurrence w/Director
(Explain below)
COMMENTS
ADMINISTRATOR, FSIS
DATE
SIGNATURE
Concurrence w/Asst. Admin.
Nonconcurrence w/Asst. Admin.
(Explain below)
COMMENTS
FSIS FORM 8822-4 (11/16/2011) page 3
CONTINUATION SHEET FOR REQUEST FOR LABEL RECONSIDERATION
PRODUCT NAME:
This sheet is being used for additional information required for company reason(s) for requesting label reconsideration.
INSTRUCTIONS FOR PREPARATION OF FSIS FORM 8822-4
FSIS Form 8822-4 is used to request label reconsideration from USDA, FSIS, Labeling and
Program Delivery Division (LPDD) for label applications (FSIS Form 7234-1) which have
been modified or rejected.
A.
PREPARATION OF APPLICATION
Application must be typed, or it will be returned without evaluation.
B.
ASSEMBLY OF APPLICATION
Attach two copies of the completed FSIS Form 8822-4 along with two copies of the rejected or
previously modified approval FSIS Form 7234-1 for which you are appealing. Include the rejection
letter if applicable. Staple with one or as few staples as possible. Do not use paper clips.
B.
MAIL COMPLETED APPLICATION TO:
USDA, FSIS, OPPD, Labeling and Program Delivery Division
Labeling Distribution Unit - APPEAL
Stop Code 3786, Patriots Plaza III, 8-168
1400 Independence Avenue, SW
Washington, DC 20250-3700
Express Mail Only:
USDA, FSIS, OPPD, Labeling and Program Delivery Division
Labeling Distribution Unit - APPEAL
Patriots Plaza III, 8-168
355 E. Street, SW
Washington, DC 20024-3221
FAX: 301-504-0873 or 301-504-0875
Telephone: 301-504-0883 (Distribution Unit)
Instructions:
Complete all sections of Page 1 on the FSIS Form 8822-4.
COMPANY REASON(S) FOR REQUESTING LABEL RECONSIDERATION. Provide a reason(s) why the
label should not have been modified or rejected. This can be a simple statement. If additional space is
needed, check the box for “Continuation Sheet” and use the Continuation Sheet provided.
Written arguments supporting the basis for the appeal must be enclosed with the appeal. In addition, all
uncontested modifications to labeling must be made prior to the submission of an appeal. When prior
approvals are mentioned in your argument, provide complete, legible copies of the prior approvals. If
numerous prior approvals are involved, provide a listing of the approval numbers and a few legible copies of
the prior approvals.
REVIEWER'S REASON FOR DISAPPROVAL OR MODIFICATION. Include the label reviewer's reason(s) for
the rejection and/or modification. If unsure, leave blank.

Download FSIS Form 8822-4 Request for Label Reconsideration

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