FORM FDA 1993 (2/06)
PREVIOUS EDITION IS OBSOLETE
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
FOOD AND DRUG ADMINISTRATION
Form Approved; OMB No. 0910-0212
Expiration Date: December 31, 2008
See Reverse for OMB Statement
NOTE: Read regulations carefully before filling out this application. A separate application must be filled out for each establishment making direct
shipment to the United States. If additional space is required, continue on reverse referring to specific item being continued.
APPLICATION FOR PERMIT TO SHIP OR TRANSPORT MILK AND/OR CREAM INTO THE UNITED STATES
Application is hereby made by a permit to ship or transport milk and / or cream
into the United States as provided by the Federal Import Milk Act of February 15, 1927.
1. Shippers name in full
2. Establishment location from which applicant ships
3. List names and locations of the dairy farm(s) from which the milk is obtained (Use separate sheet if necessary.)
4. Have the cows passed a tuberculin test applied by a duly authorized official veterinarian of the United States or of the
country in which milk or cream is produced, within one year previous to the time of the importation, showing that such
cows are free from tuberculosis?
5. Have the cows producing milk or cream been subjected to a physical examination in the past year?
If "Yes", by whom?
6. List the approximate number of cows furnishing the milk
supply proposed for importation.
7. List plant(s) and/or station(s)
8. Does applicant reside in the United States and make collections of milk or cream by his own or hired conveyances which
transport the product to the United States?
9. If the answer to Question 8 is "YES", list by name the dairy farms supplying milk to the collecting conveyances.
10. Usual means of transportation
11. Give location of customs office through which entry into the United States is made.
12. Are you the operator in the United States of a condensery or condenseries in which sterilization is a necessary process,