FDA Food Facility Registration Form
Register your food facility with the US FDA as required under Section 415 of the FD&C Act. LMG will prepare and submit your registration on your behalf.
Description of Services & Cost
| Services | Fees | Number of Services | Total Fees |
|---|---|---|---|
| Food Facility Registration, US Agent Service and Certificate of RegistrationSection 415 FD&C Act | USD 349 | $0 | |
| Additional Facility RegistrationPer additional facility at the same company | USD 199 | $0 | |
| Food Canning Establishment Registration Assistance21 CFR Part 108 — Emergency Permit Control | USD 649 | $0 | |
| Total | $0 | ||
Section 1 — Type of Registration
Fishing vessels that harvest and transport fish but do not process fish are generally exempt from food facility registration. LMG will advise whether registration is required after reviewing your application.
Section 2 — Facility Name / Address Information
Section 3 — Preferred Mailing Address Information (Complete only if different from Section 2)
Section 4 — Parent Company Name / Address Information
In this section, complete the address for the Parent Company. If the same as another section, select below.
Section 5 — Facility Emergency Contact Information
Section 6 — Trade Names (if any)
If this facility uses trade names other than that listed in Section 2 above, list them below (e.g., "Also doing business as", "Facility also known as").
Section 7 — United States Agent (For Foreign Food Facilities Only)
Liberty Management Group Ltd. will be the appointed US Agent and Official Correspondent for this facility as required under 21 CFR 1.227.
Section 8 — Seasonal Facility Dates of Operation (Optional)
Give the approximate dates that your facility is open for business, if its operations are on a seasonal basis.
Section 9 — General Product Categories
Select Human Food, Animal Food, or Both — then check all applicable product categories and the type of activity conducted at this facility for each category. Type of Activity is mandatory for each selected category.
Section 10 — Owner or Operator Information
Provide the following information if different from all other sections. If the information is the same as another section, check which section.
Section 11 — Inspection Statement
FDA will be permitted to inspect the facility at the time and in the manner permitted by the Federal Food, Drug, and Cosmetic Act. Submitting this registration does not constitute a finding by FDA that the facility or its food is in compliance with applicable US law.
Section 12 — Agreement & Certification
The owner, operator, or agent in charge of the facility, or an individual authorized by the owner, operator, or agent in charge of the facility, must submit this form. By submitting this form to FDA, or by authorizing an individual to submit this form to FDA, the owner, operator, or agent in charge of the facility certifies that the above information is true and accurate. An individual (other than the owner, operator, or agent in charge of the facility) who submits the form to the FDA also certifies that the above information submitted is true and accurate and that he/she is authorized to submit the registration on the facility's behalf. Under 18 U.S.C. 1001, anyone who makes a materially false, fictitious, or fraudulent statement to the U.S. Government is subject to criminal penalties.
1. Services Provided
Our services will be limited to registering your food facility with the US FDA. On the registration form, "Liberty Management Group Ltd." will be identified as the "U.S. Agent" and "Official Correspondent" for your facility. You understand and agree that the information your company provides to LMG will be used for the purpose of completing a public filing with, among other entities, the United States Government.
2. Client Information
You agree and warrant that all information your company provides to LMG is correct and truthful to the best of your knowledge. You further agree and warrant that you will promptly inform LMG of any changes in the Client Information that are required to be updated with the FDA.
3. Biennial Renewal
Food facility registrations must be renewed biennially between October 1 and December 31 of each even-numbered year. It is the client's responsibility to ensure that LMG is instructed to renew the registration on time. Failure to renew may result in the suspension of the facility's registration.
4. Termination Notices
Either party may terminate the relationship at any time for any reason by providing seven (7) days' written notice to the other party. In the event of terminating this Agreement by either party, LMG shall not be liable to your company for any reimbursement or damages. In no event shall LMG's liability exceed the amount of the fees paid by your company to LMG in any given calendar year.
5. Governing Law
This Agreement shall be governed by the laws of the State of Illinois, U.S.A. The parties consent to the sole and exclusive jurisdiction of the Illinois courts in Will County, Illinois.
Submitter Information
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