TTB F 5150.19 Formula and/or Process For Article Made With Specially D

OMB No. 1513-0011 xx/xx/xxxx

DEPARTMENT OF THE TREASURY
ALCOHOL AND TOBACCO TAX AND TRADE BUREAU (TTB)

FORMULA AND/OR PROCESS FOR ARTICLE MADE WITH SPECIALLY DENATURED SPIRITS
(Prepare in duplicate - See instructions below)
1.

NAME OF ARTICLE (PRODUCT) OR PROCESS IN WHICH SDA WILL BE USED

3.

FORMULA IS
NEW

5.

MANUFACTURER:

PREVIOUSLY APPROVED

NAME AND ADDRESS OF MANUFACTURER (Include Number, Street, City, State
and ZIP Code) (State former name, if successor)

IS THE PRODUCT TO BE PACKAGED IN PRESSURIZED
CONTAINERS? (Specify propellant and ratio)
YES

CODE NUMBER

4. IF PREVIOUSLY APPROVED

MAILING ADDRESS (If different from manufacturing address).

8.

2.

DATE:
6.

INDUSTRIAL USE PERMIT NO.

7.

PURPOSE FOR WHICH THIS PRODUCT IS TO BE
USED

9. SIZES OF COMMERCIAL PACKAGES

NO

10. SPECIALLY DENATURED ALCOHOL OR RUM FORMULA USED (Specify
denaturants in formulas SDA-29, SDA-38B, SDA-38F)

11. PROOF OF SDA USED

12. IS SPECIALLY DENATURED ALCOHOL OR RUM TO BE RECOVERED FROM THE MANUFACTURING PROCESS?
YES

NO

13. STATE FORMULA/PROCESS (Describe process when required by regulations)

14. SIGNATURE OF APPLICANT OR AUTHORIZED
AGENT

(Attach additional sheets if necessary)
15. DATE
16. PERSON TO BE CONTACTED CONCERNING THIS SUBMISSION
(Include Area Code, Telephone Number, and e-mail address)

FOR TTB USE ONLY
LABORATORY NUMBER SAMPLE

LABORATORY NUMBER OIL

ANALYST

DATE

TTB F 5150.19 (03/2016)

ACTION

GENERAL INSTRUCTIONS
1.

When required by 27 CFR 20.91, prepare an original and one copy of
TTB F 5150.19 for each formula or process in which specially
denatured spirits are used, and mail to Chief, Nonbeverage Products
Laboratory, 6000 Ammendale Rd., Beltsville, MD., 20705-1250.

2.

If TTB F 5150.19 covers the use of SDA Formula 39-C, also submit a
0.5 ounce sample of the essential oil used in the article. In addition,
the Chief, Nonbeverage Products Laboratory, 6000 Ammendale Rd.,
Beltsville, MD., 20705-1250, may require the submission of samples of
the finished article or any ingredient.

3.

If TTB F 5150.19 covers the following activities, a statement of
process is required:
a. The use of specially denatured spirits for laboratory or mechanical
purposes, other than the use of SDA Formulas No. 3-A, 3-C, or 30
for laboratory or mechanical purposes not in the development of a
product;
b. The use of specially denatured spirits in a manufacturing
process in which none of the spirits remain in the finished
product;
c. The use of specially denatured spirits, completely denatured
spirits, or articles in a manufacturing process in which they are to
be recovered; or
d. Where the recovered denatured spirits are to be redenatured.

4.

5.

If the specially denatured spirits are used as in paragraph 3.a. above,
the Form 5150.19, Item 13, must identify the formula number of
specially denatured spirits, a description of the laboratory or mechanical use, and the approximate annual quantity to be used.
If the specially denatured spirits are used as in paragraph 3.b., 3.c.,
or 3.d. above, the Form 5150.19 must also contain the following
information:
a. Flow diagrams clearly depicting the equipment in its relative operating sequence, with essential connecting pipelines and valves. All
major equipment must be identified as to its use. The direction of
flow through the pipelines must be accompanied by a written description of the flow of materials through the system.
b. The statement of process must describe the chemical composition
and quantity of the recovered spirits. The statement of process must
be accompanied by a statement of the intended use of the recovered
spirits.
SPECIFIC INSTRUCTIONS

ITEM 1.

State the name of the article or product. If an article is not to be
manufactured, state the use of the alcohol or rum.

ITEM 2.

State the code number for the alcohol or rum used (e.g., 111).
This designation is found in 27 CFR Part 21.

ITEM 3.

State whether this submission is new or previously approved.

ITEM 4.

If this formula has been previously approved, state the name of
the manufacturer and the date of approval.

ITEM 5.

State your company’s name and address of the manufacturing
premises as shown on your Industrial Use Permit. If your most
recent approved formula was obtained under a former name,
please state the former name also. If the formula is to be mailed
to an address different from the manufacturing premises, include
this address also.

ITEM 6.

State your Industrial Use Permit number; e.g., SDS-GA-100.

ITEM 7.

State the name or use of the article being manufactured; e.g.,
hair lotion, insect repellent, ink solvent.

ITEM 8.

State whether this article is to be packaged in pressurized
containers. If so, please state the type of propellant and the
ratio of propellant to concentrate.

ITEM 10. State the formula number of the specially denatured alcohol or
rum to be used. Also state the choice of denaturants if using
SDA-29, SDA-38B, or SDA-38F.
ITEM 11. State the proof of the spirits that will be used (190/200).
ITEM 12. State whether your manufacturing process includes recovery
of spirits. If so, please refer to General Instructions 3 and 5.
ITEM 13. State the qualitative and quantitative formula for the article being
manufactured. You may identify ingredients by generic names
rather than brand names. You may identify quantities of ingredients used in ranges rather than finite quantities. The lower
range for any ingredient may not be zero and the total range
for any ingredient must not exceed  5 percent.
If an ingredient contains ethyl alcohol, you must state the percent alcohol
by volume of that ingredient, if known, and the suppliers’ name and
approval date of TTB F 5150.19.
LABELING
TTB regulations do not require that manufacturers of articles must file and
obtain label approval. Manufacturers may voluntarily submit labels to the
Alcohol and Tobacco Tax and Trade Bureau, Alcohol Labeling and
Formulation Division, Washington, DC 20220, for a determination that the
label complies with Subpart G, 27 CFR 20.134.
NOTICE
Approval by the Administrator of formulas, samples, or statements of
process means only that they meet the standards of the Alcohol and
Tobacco Tax and Trade Bureau. The approval does not require the
Administrator to issue a permit under Subpart D of 27 CFR Part 20 to
withdraw and use specially denatured spirits in those formulas, articles, or
statements of process.
All formulas, samples, and statements of process submitted for examination are considered to be trade secrets, and are therefore protected from
public disclosure under the Freedom of Information Act, Public Law 93502, 88 Stat. 1563, 5 U.S.C. 552(b)(4).
PAPERWORK REDUCTION ACT NOTICE
This request is in accordance with the Paperwork Reduction Act of 1995.
This information is used by TTB to determine that denatured spirits are
used in an authorized manner and are safe for the consumer. The
information is required to obtain a benefit.
The estimated average burden associated with this collection is 54
minutes per respondent or recordkeeper, depending on individual
circumstances. Comments concerning the accuracy of this burden
estimate and suggestions for reducing this burden should be directed to
the Reports Management Officer, Regulations and Rulings Division,
Alcohol and Tobacco Tax and Trade Bureau, 1310 G Street, NW.,
Box 12, Washington, DC 20005.
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 5150.19 (03/2016)