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pdfOMB NO. 1513-0122 (06/30/2012)
FOR TTB USE ONLY
FORMULA #:
DEPARTMENT OF THE TREASURY
TTB ID
ALCOHOL AND TOBACCO TAX AND TRADE BUREAU (TTB)
FORMULA AND PROCESS FOR DOMESTIC
AND IMPORTED ALCOHOL BEVERAGES
1. NAME AND ADDRESS OF APPLICANT / IMPORTER
(See Instructions):
(See Instructions and Conditions at the end of this form)
SUPERSEDING
FORMULA
2. CONTACT PERSON’S PHONE NUMBER / E-MAIL ADDRESS:
3. PLANT REGISTRY / BASIC PERMIT / BREWER’S NUMBER:
1a. MAILING ADDRESS (If different than above) / FOREIGN
PRODUCER’S ADDRESS:
4. CLASS AND TYPE OF PRODUCT:
5. PRODUCT NAME:
6. QUANTITATIVE LIST OF INGREDIENTS (If more space is
needed, use space at the top of the next page or separate sheet):
7. METHOD OF MANUFACTURE / PROCESS OF PRODUCTION (If more space is
needed, use space at the top of the next page or separate sheet):
8. TOTAL YIELD:
9. ALCOHOL CONTENT OF FINISHED
PRODUCT (range may be shown):
9b. AMOUNT OF ALCOHOL
FROM BASE:
9a. AMOUNT OF ALCOHOL
FROM FLAVORS:
10. PRINTED NAME OF APPLICANT / IMPORTER:
11. BY (Signature and Title)
12. DATE:
FOR TTB USE ONLY (Items 13, 14, 15, and 16)
13.
LABELING (finished product only):
FORMULATION:
WINE PRODUCTS
Approved subject to the provisions of
The designation of the product must include a truthful and adequate
statement of composition, such as
27 CFR
DISTILLED SPIRITS PRODUCTS
Harmless coloring, flavoring, or blending materials must not
total more than 2.5% by volume of the finished product.
Sugar, dextrose, or levulose or a combination thereof must
be used in an amount not less than 2.5% by weight of the
cordial or liqueur.
The use of refining agents must not alter the basic
composition of the spirits.
The blended whiskey must contain not less than 20%
straight whiskey on a proof gallon basis.
14. DATE:
Commodity statement
The label must indicate the use of:
caramel color
certified color (other than
FD&C Yellow #5)
artificial flavor
FD&C Yellow #5
allergen(s):
15. APPROVED – TTB SPECIALIST FOR THE ADMINISTRATOR, ALCOHOL AND
TOBACCO TAX AND TRADE BUREAU
TTB F 5100.51 (11/2009) (TTB FORMS 5110.38, 5120.29 SUPERSEDED)
16. EXPIRES (IMPORT ONLY):
OMB NO. 1513-0122 (06/30/2012)
6. QUANTITATIVE LIST OF INGREDIENTS (Continued):
7. METHOD OF MANUFACTURE / PROCESS OF PRODUCTION (Continued):
proprietor product number (if none, so indicate),
drawback formula number (if none, so indicate), city
and state of the flavor manufacturer, date of approval of
the nonbeverage formula, alcohol content of the flavor or
blender (if nonalcoholic, so indicate), and a description of
any coloring material contained in the flavor or blender.
GENERAL INSTRUCTIONS
Every person who is required to file a formula under 27 CFR Parts 4, 5, 7,
19, 24, 25, and 26 must submit this form to the Advertising, Labeling, and
Formulation Division, Alcohol and Tobacco Tax and Trade Bureau, 1310 G
St., NW, Washington, D.C. 20220. Permit approval and formula approval
are required prior to manufacture/importation of any product requiring a
formula. Production may commence upon receipt by the proprietor of an
approved formula on TTB F 5100.51.
(d)
Identify all allergens added directly to the product or
contained in the flavor materials. Allergens may include
Crustacean shellfish, fish, soy (soybean(s), soya), wheat,
milk, eggs, peanuts, or tree nuts. For shellfish and tree
nuts, the label and formula must indicate the specific type
or species.
(e)
Identify the use of any artificial sweeteners.
The number of copies to be filed is as follows: one copy for TTB’s records,
and either one additional copy, or one additional copy for each facility
identified in Item 1.
If the formula is approved, one copy will be retained by TTB and the
remaining approved copy(ies) will be sent to the addressee. The addressee
will forward approved copies (or two-sided reproductions) to each facility
identified in Item 1.
Distilled Spirits only:
SPECIFIC INSTRUCTIONS
Formula # and Formula Superseded.
Number the formulas in sequence commencing with the number
“1.” An applicant who has more than one facility must use a
unique system of serial numbers that does not duplicate any
formula number used at any plant. If this formula will supersede a
previous approved formula with the same formula number, please
check the box.
Item 1.
Item 2.
Enter the contact person’s full phone number including area code
and extension, if necessary.
Item 3.
Enter the plant registry/basic permit/brewer’s notice number for each
facility that will produce or import the product.
Item 4.
The class and type must conform to one of the class and type
designations in the regulations issued under the Federal Alcohol
Administration Act. Wine products containing less than 7 percent
alcohol by volume must be designated in accordance with the
labeling regulations 27 CFR Part 24 and the Federal Food, Drug
and Cosmetic Act, 21 CFR. Do not show a EUDQGRUIDQFLIXO name
LQitem 4.
Item 6.
If any type of wine (including vermouth) is to be used in
the product, state the kind, percentage of wine to be used,
whether the wine is domestic or imported, whether the
wine contains added wine spirits, and the percentage of
alcohol by volume of the wine, and the amount of alcohol
contributed to the final product on a proof gallon basis.
(g)
If the finished product is to be labeled as containing a
particular class and type of distilled spirits (such as
“Blackberry Liqueur & Brandy” or “Coffee Liqueur & NonDairy Creamer”) the ingredients used to produce the
particular class and type of distilled spirits must be listed
in a manner so that they are distinguishable from the
remaining ingredients for the finished product.
Enter the name and complete address of the applicant or
importer, and the city and state for all other facilities where the
product will be produced if the product is produced domestically.
Item 1a. (For Domestic Products) Enter the complete mailing address of
the applicant if different than the information in Item 1.
(For Imported Products) Enter the complete name and mailing
address of the foreign producer.
Item 5.
(f)
Enter the EUDQGRUIDQFLIXO name LQ item 5GRHVNOTFRQVWLWXWH
DSSURYDOIRUXVHRQDODEHO,IDEUDQGRUIDQFLIXOQDPHKDVQRW\HW
been chosen, leave item 5 blank.
(a)
(b)
(c)
Specify the kind and quantity of each and every material
or ingredient to be used in the formulation of a batch of
the product, e.g., 100 gallons, 1000 gallons, 100 barrels.
Identify all coloring agents added directly to the product or
contained in flavor materials. Certified food colors must
be identified by FD&C number, for example “FD&C Yellow
No. 5.”
Identify flavoring or blending materials by the name of the
flavor or blender, name of the flavor or blender proprietor,
Item 7.
Show in sequence each step employed in producing the product
including the step at which the specified materials will be added
and the approximate period of time to complete production.
(For Malt Beverages) Describe in detail each special process
used to produce a beer product. Omit processes customarily
used in brewing such as pasteurization or ordinary filtration.
Item 8.
Enter the total yield of the finished product, e.g., 150 gallons,
1500 gallons, 150 barrels.
Item 9.
If the product is to be bottled at more than one alcohol content
within the same tax rate, state the alcoholic content as a range to
include all alcoholic contents at which the product will be bottled,
provided that the product does not change class and type.
Item 9a. (For Malt Beverages) Enter the percentage of alcohol derived
from flavors or other materials containing alcohol.
Item 9b. (For Malt Beverages) Enter the percentage of alcohol derived
from the malt base of the product.
Item 10. (For Domestic Products) Applicant is the person required to file
a formula under TTB regulations.
(For Imported Products) Importer is the person who imports the
product.
CONDITIONS FOR FORMULA APPROVAL
This approval is granted under 27 CFR Parts 4, 5, 7, 19, 24, 25, and 26 and
does not in any way provide exemption from or waiver of the provisions of
the Food and Drug Administration regulations relating to the use of food and
color additives in food products.
Addition of remnants or returned merchandise to a completed product made
under the same formula is permitted.
PAPERWORK REDUCTION ACT NOTICE
This request is in accordance with the Paperwork Reduction Act of 1995. We collect this information to verify your compliance with Federal laws and regulations we administer for the formulation of alcohol
beverages. The information is mandated by statute (26 U.S.C. Chapter 51) and is used to obtain a benefit. The information collected on this form must be considered confidential tax information under
26 U.S.C. 6103, and must not be disclosed to any unauthorized party under 26 U.S.C. 7213.
We estimate 2 hours as the average burden for you to complete this form depending on your individual circumstances. You may comment to us about the accuracy of this burden estimate and suggest
ways for us to reduce the burden. Address your comments or suggestions to: Reports Management Officer, Regulations and Rulings Division, Alcohol and Tobacco Tax and Trade Bureau,
Washington, DC 20220.
An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a current, valid OMB control number.
TTB F 5100.51 (11/2009) (TTB FORMS 5110.38, 5120.29 SUPERSEDED)
File Type | application/pdf |
File Title | DEPARTMENT OF THE TREASURY |
Subject | Uni-Form |
Author | James Neely |
File Modified | 2009-11-12 |
File Created | 2006-04-06 |