Form FDA1993 "Application for Permit to Ship or Transport Milk and/or Cream Into the United States"

What Is Form FDA1993?

This is a legal form that was released by the U.S. Department of Health and Human Services - U.S. Food and Drug Administration on August 1, 2018 and used country-wide. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on August 1, 2018;
  • The latest available edition released by the U.S. Department of Health and Human Services - U.S. Food and Drug Administration;
  • 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 Form FDA1993 by clicking the link below or browse more documents and templates provided by the U.S. Department of Health and Human Services - U.S. Food and Drug Administration.

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Download Form FDA1993 "Application for Permit to Ship or Transport Milk and/or Cream Into the United States"

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Form Approved: OMB No. 0910-0212
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
Expiration Date: 08-31-21
FOOD AND DRUG ADMINISTRATION
See Reverse for OMB Statement
APPLICATION FOR PERMIT TO SHIP OR TRANSPORT MILK AND/OR CREAM INTO THE UNITED STATES
NOTE:
Read regulations carefully before filling out this application. A separate application must be filled out for each establishment making direct
shipment to the United States. If additional space is required, continue on reverse referring to specific item being continued.
Application is hereby made by a permit to ship or transport milk and/or cream
into the United States as provided by the Federal Import Milk Act of February 15, 1927.
1. Shipper's name in full
2. Establishment location from which applicant ships
3. List names and locations of the dairy farm(s) from which the milk is obtained (Use separate sheet if necessary.)
YES
4. Have the cows passed a tuberculin test applied by a duly authorized official veterinarian of the United States or of the
country in which milk or cream is produced, within one year previous to the time of the importation, showing that such
NO
cows are free from tuberculosis?
YES
5. Have the cows producing milk or cream been subjected to a physical examination in the past year?
If "Yes", by whom?
NO
7. List plant(s) and/or station(s)
6. List the approximate number of cows furnishing the milk
supply proposed for importation.
YES
8. Does applicant reside in the United States and make collections of milk or cream by his own or hired conveyances which
transport the product to the United States?
NO
9. If the answer to Question 8 is "YES", list by name the dairy farms supplying milk to the collecting conveyances.
10. Usual means of transportation
a.
TRUCK
b.
RAILROAD
c.
OTHER (Specify)
11. Give location of customs office through which entry into the United States is made.
YES
12. Are you the operator in the United States of a condensery or condenseries in which sterilization is a necessary process,
and which condensery or condenseries are within 15 miles of the point of production of the milk or cream?
NO
YES
13. If the answer to Question 12 is "YES", do you wish to have waived the requirements of paragraph 4 of Section 2 of the
act when a permit is issued to you?
NO
14. If the answer to Question 12 is "YES", give name and location of such condensery or condenseries.
YES
15. Are you the operator of or a producer shipping to a creamery or condensery in the United States within 20 miles of the
point of production of the milk? State whether operator or producer.
NO
YES
16. If the answer to Question 15 is "YES", do you import raw milk for any purpose other than pasteurization, condensation,
or evaporation?
NO
17. If the answer to Question 15 is "YES", give names and locations of creameries or condenseries.
18. Name of milk or cream product involved
19.
21. Address to which permit is to be sent
20. Title and signature of officer of corporation or
partnership
Corporation
Partnership
FORM FDA 1993 (8/18)
PSC Publishing Services (301) 443-6740 EF
PREVIOUS EDITION IS OBSOLETE
Form Approved: OMB No. 0910-0212
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
Expiration Date: 08-31-21
FOOD AND DRUG ADMINISTRATION
See Reverse for OMB Statement
APPLICATION FOR PERMIT TO SHIP OR TRANSPORT MILK AND/OR CREAM INTO THE UNITED STATES
NOTE:
Read regulations carefully before filling out this application. A separate application must be filled out for each establishment making direct
shipment to the United States. If additional space is required, continue on reverse referring to specific item being continued.
Application is hereby made by a permit to ship or transport milk and/or cream
into the United States as provided by the Federal Import Milk Act of February 15, 1927.
1. Shipper's name in full
2. Establishment location from which applicant ships
3. List names and locations of the dairy farm(s) from which the milk is obtained (Use separate sheet if necessary.)
YES
4. Have the cows passed a tuberculin test applied by a duly authorized official veterinarian of the United States or of the
country in which milk or cream is produced, within one year previous to the time of the importation, showing that such
NO
cows are free from tuberculosis?
YES
5. Have the cows producing milk or cream been subjected to a physical examination in the past year?
If "Yes", by whom?
NO
7. List plant(s) and/or station(s)
6. List the approximate number of cows furnishing the milk
supply proposed for importation.
YES
8. Does applicant reside in the United States and make collections of milk or cream by his own or hired conveyances which
transport the product to the United States?
NO
9. If the answer to Question 8 is "YES", list by name the dairy farms supplying milk to the collecting conveyances.
10. Usual means of transportation
a.
TRUCK
b.
RAILROAD
c.
OTHER (Specify)
11. Give location of customs office through which entry into the United States is made.
YES
12. Are you the operator in the United States of a condensery or condenseries in which sterilization is a necessary process,
and which condensery or condenseries are within 15 miles of the point of production of the milk or cream?
NO
YES
13. If the answer to Question 12 is "YES", do you wish to have waived the requirements of paragraph 4 of Section 2 of the
act when a permit is issued to you?
NO
14. If the answer to Question 12 is "YES", give name and location of such condensery or condenseries.
YES
15. Are you the operator of or a producer shipping to a creamery or condensery in the United States within 20 miles of the
point of production of the milk? State whether operator or producer.
NO
YES
16. If the answer to Question 15 is "YES", do you import raw milk for any purpose other than pasteurization, condensation,
or evaporation?
NO
17. If the answer to Question 15 is "YES", give names and locations of creameries or condenseries.
18. Name of milk or cream product involved
19.
21. Address to which permit is to be sent
20. Title and signature of officer of corporation or
partnership
Corporation
Partnership
FORM FDA 1993 (8/18)
PSC Publishing Services (301) 443-6740 EF
PREVIOUS EDITION IS OBSOLETE
This section applies only to requirements of the Paperwork Reduction Act of 1995.
*DO NOT SEND YOUR COMPLETED FORM TO THE PRA STAFF EMAIL ADDRESS BELOW.*
The burden time for this collection of information is estimated to average .5 hour per response, including the time to
review instructions, search existing data sources, gather and maintain the data needed and complete and review the
collection of information. Send comments regarding this burden estimate or any other aspect of this information
collection, including suggestions for reducing this burden, to:
Department of Health and Human Services
Food and Drug Administration
Office of Chief Information Officer
Paperwork Reduction Act (PRA) Staff
PRAStaff@fda.hhs.gov
“An agency may not conduct or sponsor, and a person is not required to respond to, a collection of
information unless it displays a currently valid OMB number.”
FORM FDA 1993 (8/18)
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