SPECIFICATION AND LABEL SUBMITTAL ACTION REQUEST NOAA Form 89-819

OMB Control No.: 0648-0266
Expiration Date: 07/31/2008

NOAA FORM 89-819
(03-06)
Prescribed by NOAA Inspection Manual

U.S. DEPARTMENT OF COMMERCE
NATIONAL OCEANIC AND ATMOSPHERIC ADMINISTRATION
SEAFOOD INSPECTION PROGRAM

SPECIFICATION AND LABEL SUBMITTAL ACTION REQUEST
INSTRUCTIONS – Please print for complete by typewriter. Submit a set
of 5 specifications and/for labels with each product label indicated on
form. All copies except field copy to be submitted to the address below or
action. Field copy to be retained by requestor until specifications and/or
labels are returned by Approving Officer.
TO: DOCUMENTATION APPROVAL and SUPPLY SERVICES
P.O. DRAWER 1207 – 3207 FREDERIC ST., SUITE B
PASCAGOULA, MISSISSIPPI 39568-1207

1. DATE SUBMITTED

2. PLANT CODE(S)

3. PROCESSOR OR PACKER (Name, address and Phone Number)

4. DISTRIBUTOR (Name and full address)

USDC No. (Item 5) to be assigned by Approving Officer. Indicate USDC Number of approved specifications or labels in Remarks when submitting
replacements with minor changes, or when submitting or verification for cancellation. Indicate primary logo, packer or distributor name, or other identification
for item 6. Use numbers only or item 9: 1 - No. Shield 2 - Combination Grade A & PUFI., 3 - PUFI Mark, 4 - Grade A, 5 - Lot Inspected Mark
6. PRODUCT IDENTIFICATION 7. COMMODITY (Use official terminology including type, style and size;
8. CONTENT
9. SHIELD
5. USDC NUMBER
indicate in ounces or count/pounds. Enter 10 digit commodity code)
OR
CODE
(Brand and identifying number if any)
(See Above)
LABEL
SPEC.
PRODUCT
COMMODITY CODE
NET WEIGHT

10. USDC INSPECTOR (Signature)

Inspector Number

HACCP

COMPANY OFFICIAL (Signature)

11. HAVE SPECIFICATIONS AND/FOR LABELS BEEN
REVIEWED FOR COMPLIANCE WITH USDC AND FDA
REGULATIONS?
BY INSPECTOR?
BY FIELD INSPECTION OFFICER?
YES
NO
YES
NO

12. ACTION REQUESTED
LABEL/SPEC. REVIEW
NEW LABEL SKETCH/PROOF REVIEW
NEW SPEC. APPROVAL (FINAL)
REPLACEMENT SPEC. OR LABEL
USDA/FNS (CN) LABEL OR SPECS ACTION

NEW LABEL APPROVAL (FINAL)
CANCEL APPROVAL
OTHER (SPECIFY IN REMARKS)
EXTEND TEMPORARY APPROVAL (SPECIFY IN REMARKS)

APPROVAL BY THE USDC IS BASED ON THE INFORMATION SUPPLIED AND DOES NOT IMPLY CONCURRENCE FOR ACCEPTANCE BY OTHER
FEDERAL STATE FOR LOCAL GOVERNMENTAL AGENCIES UNLESS SPECIFICALLY NOTED, NOR DOES IT RELIEVE THE COMPANY FROM
COMPLIANCE WITH OTHER APPLICABLE LAWS, REGULATIONS OR RULINGS. THIS APPROVAL BECOMES VOID IF CHANGES ARE MADE IN THE
SPECIFICATION OR LABEL WITHOUT THE CONCURRENCE OF THE USDC APPROVING OFFICER.
13. REMARKS (Please initial)

TO BE COMPLETED BY APPROVING OFFICE(S) ONLY
PROOF APPROVED FOR PRINTING
AS IS WITH CHANGES NOTED
Temporary Approval Expires
(Spec)
(Label)
Final Approval Label
Final approval Spec.
Disapproved label
Disapproved Spec.
Extends Approval
Cancelled
Reviewed

APPROVING OFFICER (Signature)
USDA/FNS USE ONLY
SKETCH/PROOF
LABEL
USDA APPROVAL (Signature)

DATE:

CONCURRENCE

NON-CONCURRENCE
DATE:

INFORMATION COLLECTION NOTIFICATION
NOAA Form 88-819
This information collection is authorized under 50 CFR §260.97(c)(12), (13), and (15).
The information will be used to ensure compliance with mandatory labeling regulations
established by the U.S. Food and Drug Administration as well as the proper used of the
official marks of the voluntary National Seafood Inspection Program. Public reporting
burden for this collection of information is estimated to average 30 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. Send comments regarding this burden estimate or any other aspect of the
collection of information, including suggestions for reducing this burden, to the National
Seafood Inspection Program, 1315 East-West Highway, Silver Spring, MD 20910. This
information is required in order to obtain the benefits of the use of official marks [50 CFR
§260.86].
Notwithstanding any other provision of the law, no person is required to respond to, nor
shall any person be subject to a penalty for failure to comply with, a collection of
information subject to the requirements of the Paperwork Reduction Act, unless that
collection of information displays a currently valid OMB Control Number.