Fsis Form 7234 1 PDF Details

The Fsis Form 7234 1 is a document used to request certification of eligibility for export of meat or poultry products. This form is used by individuals or companies who wish to export meat or poultry products to a foreign country. The Fsis Form 7234 1 is also known as the Eligibility Certification for Export of Meat and Poultry Products form. completing this form correctly is important, as it will help ensure that your meat or poultry products are exported successfully. Make sure you have all the information you need before you start filling out this form.

In the table, there is some good information about the fsis form 7234 1. Before you decide to fill in the form, it's definitely worth checking more details on it.

QuestionAnswer
Form NameFsis Form 7234 1
Form Length5 pages
Fillable?Yes
Fillable fields1
Avg. time to fill out1 min 27 sec
Other names7234 1, fsis label approval form, usda form approval, usda label approval form

Form Preview Example

7a. AREA OF PRINCIPAL DISPLAY PANEL (Square Inches)
7b. TOTAL AVAILABLE LABELING SPACE FOR ENTIRE PACKAGE (Square inches):
Poultry
Other
Egg
Meat
4a. TYPE OF PRODUCT
3. FOR USDA USE ONLY
PAGE of
4. ESTABLISHMENT NO. / FOREIGN COUNTRY (If applicable)

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 75 minutes 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. This form had been approved by OMB for web distribution.

U.S. DEPARTMENT OF AGRICULTURE

FOOD SAFETY AND INSPECTION SERVICE

APPLICATION FOR

APPROVAL OF LABELS,

MARKING OR DEVICE

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).

APPLICANT: See Page 5 for instructions.

1.AGENT NAME, ADDRESS, TELEPHONE NO. (If using an Agent, complete this block, otherwise leave blank.)

2. FOR USDA USE ONLY

5a. NAME OF PRODUCT

5b. HACCP PROCESS CATEGORY (Select one)

03J: Slaughter - all species

03B: Raw Product - ground

03C: Raw Product - not ground

03D: Thermally processed - commercially sterile

03E: Not heat treated - shelf stable

6a. TYPE OF APPROVAL REQUESTED

SKETCH TEMPORARY

EXTENSION OF TEMPORARY

6b. WAS THE LABEL PREVIOUSLY APPROVED? YES Date of approval:

03F: Heat treated - shelf stable 03G: Fully cooked - not shelf stable

03H: Heat treated but not fully cooked - not shelf stable

03I: Product with secondary inhibitors - not shelf stable

NO

Prior approval number: Number of labels on hand: Number of days requested:

 

 

8. Does this label include a "USDA-AMS Child Nutrition Program CN-Logo?

 

 

Yes

 

No

 

 

9. (FOR USDA-AMS USE ONLY) CN Identification Number Assigned

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

10. Are there any special claims, guarantees, or foreign language on the label?

 

 

YES

 

NO (If yes, check all that apply)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Allergen Statements

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Other Claims: Specify

 

 

 

 

 

 

Animal Production/Breed/Raising

 

 

Grading Terms

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Certified/Verified

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Guarantees

 

 

 

 

 

 

 

 

 

 

 

Environmental/Green

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Natural/Organic

 

 

 

 

 

 

 

 

 

 

 

Export Only Labels w/deviations from Domestic Requirements

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Foreign Language

 

 

Nutrition/Health

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Geographic/Undefined Style

 

 

Religious Exemption

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

11. NAME AND ADDRESS OF FIRM (Below and between dots)

 

 

 

 

 

 

12. SIGNATURE OF APPLICANT OR AGENT

13. DATE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

14. (FOR USDA USE ONLY) CONDITIONS APPLYING TO USE OF LABELS OR DEVICE

FSIS FORM 7234-1 (11/16/2011)

REPLACES FSIS FORM 7234-1 (09/01/2009), WHICH IS OBSOLETE.

FSIS FORM 7234-1 (11/16/2011) page 2

15. PRODUCT FORMULA

PAGE of

PCT

 

WEIGHT

(No Fractions)

 

 

See Continuation Sheet

TOTAL (Percent must total 100%)

 

 

 

 

FSIS FORM 7234-1 (11/16/2011) page 3

PAGE

 

of

 

 

 

 

16. PROCESSING PROCEDURES (Approval of the sketch does not convey approval of the processing procedures)

See Continuation Sheet

FSIS FORM 7234-1 (11/16/2011) page 4

PAGE

 

of

 

 

 

 

 

 

 

 

 

 

CONTINUATION SHEET FOR APPLICATION FOR APPROVAL OF LABELS,

MARKING OR DEVICE (FSIS 7234-1)

PRODUCT NAME:

This sheet is being used for additional information required in Block(s):

INSTRUCTIONS FOR PREPARATION OF FSIS FORM 7234-1

Note: The following instructions should be typed unless otherwise noted.

A.

PREPARATION OF APPLICATION

7b.

Total available labeling space in square inches for entire package.

 

Application must be typed or it will be returned without evaluation.

8.

USDA-AMS Child Nutrition Program Logo. Indicate if the product

 

Submit two copies for each label application.

 

 

 

includes a USDA-AMS Child Nutrition Program Logo.

B.

TYPE OF APPROVAL REQUESTED

9.

Leave Blank. For USDA-AMS use only.

 

Sketch: Self explanatory. (See 9 CFR 317.4 & 381.132)

 

 

 

 

Temporary and Extension of Temporary. Actual label or color litho take off to be used.

10.

Special claims, guarantees, or foreign language. Indicate if there are

 

 

 

are any special claims, guarantees, or foreign language on the label.

C.

FOREIGN LANGUAGE

 

Check all that apply. If Other Claims is selected, indicate specific claim(s)

 

Labels printed in foreign languages must be accompanied by English language translation.

 

 

 

in space provided.

 

 

 

D.

ASSEMBLY OF APPLICATION

11.

Name and Address of Firm. Insert Firm's name and mailing

 

Application Form, Product Formula, Processing Procedures, Continuation Sheet if applicable, Label,

 

address. Use 2 letter symbol for State. Show postal zip code.

 

and any Supporting Documentation Staple with one or as few staples as possible. (Do not use paper

12 & 13.

Signature and Date of Applicant or Agent. To be signed and

 

clips).

 

 

 

dated by the applicant or agent representing the official

E.

MAIL COMPLETED APPLICATION TO:

 

establishment or plant.

 

 

 

USDA, FSIS, OPPD, LPDD

14.

 

 

Labeling Distribution Unit

Leave blank for USDA use only. Conditions Applying to Use of Label or

 

 

 

Stop Code 3786, Patriots Plaza III, 8-168

 

Device. (Any condition, modification or remarks applied to the application

 

1400 Independence Avenue, SW

 

when approved are conditions governing use of the approved devices.)

 

Washington, DC 20250-3700

 

 

The following instructions relate to numbered items on form.

15.

Product Formula. List the ingredients by percent or weight in order of

1.

If using an Agent, provide the company name, address, and telephone number,

 

their predominance. If product consists of several components, e.g.,

 

a frozen dinner, list each component separately and indicate the

 

otherwise leave blank.

 

percentage or amount of each component in the product. If additional

2 & 3.

Leave blank, for USDA use only.

 

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. Express all ingredients in the same units, i.e., do not

4.

Establishment No./Foreign Country (if applicable) - Self Explanatory.

 

list some in pounds and others in ounces.

4a.

Type of Product. Select one product type: Egg, Meat, Poultry, or Other (i.e. Exotic Species,

 

 

Non-Amenable, Voluntary, etc.)

 

Check whether weight or percent is used. It is preferred that

 

 

5a.

Name of Product. Use common or descriptive product name, i.e., "Frankfurter ,

 

percentages be used, and the total must equal 100 percent. If weights

 

are used, show in pounds, kilograms or grams. (No gallons, pints,

 

Cereal Added" or "Meat Patties in Gravy. (Do not use trade brand names or

 

 

 

cups, teaspoons, etc.) The total must equal the weights of the

 

coined names, such as "Joe's Corn Dogs" or "Joe's Sloppy Joes.") If coined

 

 

 

individual units. (Example: Crust + Cheese + Sauce + Meat = Total

 

names such as "Corn Dogs" are used, also show true product name, such as

 

 

 

new weight of unit.)

 

"Batter Wrapped Wiener."

 

 

 

 

5b.

Provide HACCP process category for the product. See 9 CFR 417.2(b) (1),

 

DO NOT use fractions. Express as decimals carried to two places, Example:

 

Example, Heat Treated - shelf stable, Not heat treated-shelf stable etc. Select one.

 

1-1/4 lbs., show as 1.25 lbs. Example: 3/4 lbs., show as .75 lbs.

6a & b.

Type of Approval Requested. 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)

16.

Processing Procedures. Poultry Products provide complete

 

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.

 

processing procedures as required in 9 CFR 381.134. Meat

 

Be sure to include product name and block item.

 

Products, provide complete processing procedures as required.

 

 

 

Note: Approval of the sketch does not convey approval of the

7a.

Area of Principal Display Panel (PDP). The PDP is the entire side

 

processing procedures. If additional space is needed, check the box for

 

"Continuation Sheet," and use the Continuation Sheet.

of the package to which the label is affixed. See 9 CFR 317.2 (d)

Be sure to include the product name and number of the block item.

and 381.116 (b).

 

 

 

FSIS FORM 7234-1 (11/16/2011)

 

How to Edit Fsis Form 7234 1 Online for Free

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Step 1: Click the "Get Form Now" button to begin the process.

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7234 1 blanks to complete

Enter the required details in the box Yes, YES, If, yes, check, all, that, apply Other, Claims, Specify Religious, Exemption SIGNATURE, OF, APPLICANT, OR, AGENT and DATE.

step 2 to entering details in 7234 1

Inside the area dealing with FS, IS, FORM, page PRODUCT, FORMULA PAGE, PCT, No, Fractions and WEIGHT, you will need to put down some demanded details.

step 3 to completing 7234 1

The See, Continuation, Sheet and TOTAL, Percent, must, total box is the place where both sides can indicate their rights and responsibilities.

Filling in 7234 1 part 4

Check the sections FS, IS, FORM, page and PAGE and thereafter fill them out.

step 5 to finishing 7234 1

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