Register FDA | Prior Notice Filing Form

Please provide general shipment information*
- Express courier (via airplane)
- Baggage (on an airplane)
- Express courier (via truck)
- Sea (via ship)
- Land (via truck, train, or car)
- Mail (via postal service)
IATA Code or Carrier Name:*
Enter the International Air Transport Association (IATA) 2-character Carrier Code. If you do not know the IATA Code, please provide the Carrier Name.
Carrier Alpha Code (SCAC) or Carrier Name*
Enter the Standard Carrier Alpha Code (SCAC). If you do not know teh SCAC Code, please provide the Carrier Name.
Tracking number:*
Enter the Tracking Number assigned to you by the Express Courier.
Bill of Lading - Master:*
Container Numbers:
Enter one or more container numbers, separated by commas, each with minimum one character and maximum up to twenty characters.
Anticipated Arrival Date:*
Anticipated Arrival Time:*

: HH

MM

(24-hour clock HH:MM)
Anticipated Shipment Date:*
Country from which the Article is Shipped:*
Shipping to U.S. State:*
Port Name:*
Port Codes (Optional)
Port Codes - NORTHEAST REGION
Port Codes - NEW YORK REGION
Port Codes - NORTH CENTRAL REGION
Port Codes - SOUTHEAST REGION
Port Codes - SOUTH CENTRAL REGION
Port Codes - SOUTHWEST REGION
Port Codes - PACIFIC REGION

Importer Information
Company Name:*
Food Facility Registration Number:
You may also provide the Importer's Food Facility Registration Number, if known.
Importer Address:*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Importer Contact Name:*
Prefix First Last
Phone:*
Email Address:*

Product Information
How many different food products are included in your shipment?*
(Note: Each variety of product should be counted as different product. Also, each packaging size should be counted as a different product.)
Product Name:*
Common or Usual Name/Market Name
Detailed Product Description:
Production Identifiers (optional):
Production Identifiers are the Lot Codes, Production Codes, or other identifiers associated with products.
Select Product Industry:*
Packaging Method:*
Process Applied:*
Packaging*
Please describe in detail how your shipment is packaged. Enter the base unit for this article. This is the quantity contained in the smallest package you are shipping. For example, a 12 ounce can or a 750 milliliter bottle. Next, described from the largest container to smallest package size (up to five packaging levels may be provided). For example, 500 Cases, with 40 Cans per Case (The weight of the individual can is the base unit).
Number of Base Units:*
Enter the weight or volume of the smallest (Base) unit. For example, 16 if the smallest unit is a 16 oz can.
Measure of Base Units:*
Food Quantity
For packaged food, provide the estimated quantity of food that will be shipped, described from the largest container to smallest package size. For example, 500 Cases, with 40 Cans per Case (The weight of the individual can is the base unit).
Largest Package:
Largest Package Type
Next Size Package:
Next Size Package Type
Smallest Size Package:
Smallest Size Package Type
Total Quantity:

Manufacturer or Food Facility Name:*
Facility FDA Registration Number:
Manufacturer Address:*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Shipper Address*
Same as Importer

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Owner's address*
Same as importer

Street Address City State / Province / Region ZIP / Postal Code Country
Has the product listed above ever been refused entry to another country?*
- No, this product has never been refused entry to another country?
- Yes, this product has been refused from:
Country of refusal:*
Country
Certification Statement*
By submitting this form to register-FDA, or by authorizing an individual to submit this form to register-FDA, the owner or operator in charge of the facility certifies that the above information is true and accurate. The owner or operator in charge of the facility also authorizes register-FDA to submit the Prior Notice on the facility's behalf.
- I agree
- I don't agree

Prior Notice Form