FSIS Form 7234-1 at a glance
What it is: FSIS Form 7234-1 is the Application for Approval of Labels, Marking or Device of the U.S. Department of Agriculture Food Safety and Inspection Service.
Who signs: To be signed and dated by the applicant or agent representing the official establishment or plant.
What to bring and attach to FSIS Form 7234-1
Submit two copies for each label application.
Application must be typed or it will be returned without evaluation.
Staple the Application Form, Product Formula, Processing Procedures, Continuation Sheet if applicable, Label, and any Supporting Documentation with one or as few staples as possible. Do not use paper clips.
A filled-in FSIS Form 7234-1 example: a sketch approval for a raw ground pork sausage label
How to fill out FSIS Form 7234-1, box by box
Boxes 1 to 4, the agent and the establishment
If using an Agent, provide the company name, address, and telephone number, otherwise leave blank.
Boxes 2 and 3: leave blank, for USDA use only.
Box 4: Establishment No./Foreign Country (if applicable).
Boxes 4a to 5b, the product and its HACCP process category
Box 4a, Type of Product: select one product type: Egg, Meat, Poultry, or Other (i.e. Exotic Species, Non-Amenable, Voluntary, etc.).
Box 5a, Name of Product: use common or descriptive product name, i.e., "Frankfurter , Cereal Added" or "Meat Patties in Gravy.
Do not use trade brand names or coined names, such as "Joe's Corn Dogs" or "Joe's Sloppy Joes." If coined names such as "Corn Dogs" are used, also show true product name, such as "Batter Wrapped Wiener."
Provide HACCP process category for the product. See 9 CFR 417.2(b) (1), Example, Heat Treated - shelf stable, Not heat treated-shelf stable etc. Select one.
Boxes 6a and 6b, the type of approval and the previous approval
Type of Approval Requested: Sketch: Self explanatory. Temporary and Extension of Temporary (See 9 CFR 317.4 & 381.132): Actual label or color litho take off to be used.
If temporary approval or extension, insert number of days requested and number of labels on hand. If previous approval, attach copy of application and label.
Include specific reason(s) why requesting a temporary or extension and include information required in 9 CFR 317.4(f) (1) or 381.132(f) (1) on the continuation sheet. Be sure to include product name and block item.
Boxes 7a and 7b, the display panel and the labeling space
Box 7a, Area of Principal Display Panel (PDP): the PDP is the entire side of the package to which the label is affixed.
Box 7b: total available labeling space in square inches for entire package.
Boxes 8 and 9, the Child Nutrition Program logo
Box 8: Indicate if the product includes a USDA-AMS Child Nutrition Program Logo.
Box 9: Leave blank. For USDA-AMS use only.
Box 10, special claims, guarantees or foreign language
Are there any special claims, guarantees, or foreign language on the label? NO YES (If yes, check all that apply)
If Other Claims is selected, indicate specific claim(s) in space provided.
Foreign Language: Labels printed in foreign languages must be accompanied by English language translation.
Box 11, Name and Address of Firm
Insert Firm's name and mailing address. Use 2 letter symbol for State. Show postal zip code.
Boxes 12 and 13, Signature and Date of Applicant or Agent
Boxes 12 and 13: Signature and Date of Applicant or Agent.
Box 14, conditions applying to use of label or device
Leave blank for USDA use only.
Box 15, product formula
List the ingredients by percent or weight in order of their predominance.
If product consists of several components, e.g., a frozen dinner, list each component separately and indicate the percentage or amount of each component in the product.
Express all ingredients in the same units, i.e., do not list some in pounds and others in ounces. Check whether weight or percent is used.
It is preferred that percentages be used, and the total must equal 100 percent.
If weights are used, show in pounds, kilograms or grams. (No gallons, pints, cups, teaspoons, etc.) The total must equal the weights of the individual units.
DO NOT use fractions. Express as decimals carried to two places, Example: 1-1/4 lbs., show as 1.25 lbs. Example: 3/4 lbs., show as .75 lbs.
Box 16, processing procedures
Poultry Products provide complete processing procedures as required in 9 CFR 381.134. Meat Products, provide complete processing procedures as required.
Approval of the sketch does not convey approval of the processing procedures.
The Continuation Sheet
If additional space is needed, check the box for "Continuation Sheet," and use the Continuation Sheet. Be sure to include the product name and number of the block item.
On the Continuation Sheet for Application for Approval of Labels, Marking or Device, enter the Product Name and the Block(s): this sheet is being used for additional information required.
More rules for FSIS Form 7234-1
FSIS has determined that information provided in items 11, 15, and 16 is exempt from mandatory disclosure under the Freedom of Information Act 5 U.S.C. 552(b)(4).
Common questions about FSIS Form 7234-1
Where do I file it?
Mail completed application to: USDA, FSIS, OPPD, LPDD Labeling Distribution Unit Stop Code 3786, Patriots Plaza III, 8-168 1400 Independence Avenue, SW, Washington, DC 20250-3700.
Sources
[1] FSIS Form 7234-1 (11/16/2011), Application for Approval of Labels, Marking or Device, U.S. Department of Agriculture Food Safety and Inspection Service (the Official source link on this page).
