21 C.F.R. § 80.21
A request for certification of a batch of color additive shall:
(g) Be accompanied by the sample prescribed in § 80.22 consisting of:
(2) Two ounces in the case of repacks and mixtures.
A sample accompanying a request for certification must be submitted under separate cover and should be addressed to the Color Certification Branch.
(h) The name of a color additive shall be given in the following manner:
(j) The form for submission of the application shall be one of the following, depending upon whether the color additive is a straight color, a lake, a repack of a previously certified color additive, or a color additive mixture.
(1) Request for certification of a batch of straight color additive.
Date ________ Office of Cosmetics and Colors (HFS-100), Center for Food Safety and Applied Nutrition, Food and Drug Administration, 5001 Campus Dr., College Park, MD 20740 In accordance with the regulations promulgated under the Federal Food, Drug, and Cosmetic Act, we hereby make application for the certification of a batch of straight color additive. Name of color (As listed in 21 CFR part 74) Batch number (Manufacturer's number) Batch weighs ____ pounds Batch manufactured by ____________ at __________________ (Name and address of actual manufacturer) How stored pending certification (State conditions of storage, with kind and size of containers, location, etc.) Certification requested of this color for use in (State proposed uses) Required fee, $____ (drawn to the order of Food and Drug Administration). The accompanying sample was taken after the batch was mixed in accordance with 21 CFR 80.22 and is accurately representative thereof. (Signed) ____________________ By ____________________ ____________________ (Title)
(2) Request for certification of a batch of color additive lake.
Date ________ Office of Cosmetics and Colors (HFS-100), Center for Food Safety and Applied Nutrition, Food and Drug Administration, 5001 Campus Dr., College Park, MD 20740 In accordance with the regulations promulgated under the Federal Food, Drug, and Cosmetic Act, we hereby make application for the certification of a batch of color additive lake. Name of color Batch number (Manufacturer's number) Batch weighs ____ pounds Name of color used Quantity ____ pounds Lot number (When certification of the lake for use in foods is requested) Precipitant used Substratum used Quantity ____ pounds Batch manufactured by __________ at ______________ (Name and address of actual manufacturer) How stored pending certification (State conditions of storage, with kind and size of containers, location, etc.) Certification requested of this color for use in (State proposed uses) Required fee, $____ (drawn to the order of Food and Drug Administration). The accompanying sample was taken after the batch was mixed in accordance with 21 CFR 80.22 and is accurately representative thereof. (Signed) ____________________ By ____________________ ____________________ (Title)
(3) Request for certification of a repack of a batch of certified color additive.
Date __________ Office of Cosmetics and Colors (HFS-100), Center for Food Safety and Applied Nutrition, Food and Drug Administration, 5001 Campus Dr., College Park, MD 20740 In accordance with the regulations promulgated under the Federal Food, Drug, and Cosmetic Act, we hereby make application for the certification of a batch of color additive repack. Name of color (As listed in regulations and as certified; or repacker's name, if a mixture) Original lot number Certified color content This color obtained from Batch number Batch weighs ____ pounds How stored pending certification (State conditions of storage, with kind and size of containers, location, etc.) Certification requested for use in (State proposed uses) Required fee, $____ (drawn to the order of Food and Drug Administration). The accompanying sample was taken after the batch was mixed in accordance with 21 CFR 80.22 and is accurately representative thereof. (Signed) __________________ By ____________________ ____________________ (Title)
(4) Request for certification of a batch of color additive mixture.
Date __________ Office of Cosmetics and Colors (HFS-100), Center for Food Safety and Applied Nutrition, Food and Drug Administration, 5001 Campus Dr., College Park, MD 20740 In accordance with the regulations promulgated under the Federal Food, Drug, and Cosmetic Act, we hereby make application for the certification of a batch of color additive mixture. Name of mixture (Manufacturer's trade name) Batch number (Manufacturer's number) Weight of batch ____ pounds Volume of batch ____ (If liquid) gallons Batch manufactured by Constituents of the mixture: 1. Color(s). (List separately each color and each lot number.) Name of color as certified Lot number Quantity used (in pounds) Obtained from 2. List of diluents. (List separately each diluent.) Name of diluent Quantity used By volume By weight (if liquid) Batch mixed as follows (Describe in detail) How stored pending certification (State conditions of storage, with kind and size of containers, location, etc.) Certification requested for use in (State proposed uses) Required fee, $____ (drawn to the order of Food and Drug Administration). The accompanying sample was taken after the batch was mixed in accordance with 21 CFR 80.22 and is accurately representative thereof. (Signed) ____________________ By __________________ ____________________ (Title)
[42 FR 15662, Mar. 22, 1977; 44 FR 17658, Mar. 23, 1979; 44 FR 22053, Apr. 13, 1979, as amended at 54 FR 24890, June 12, 1989; 61 FR 14479, Apr. 2, 1996; 66 FR 56035, Nov. 6, 2001; 81 FR 49895, July 29, 2016]