Get New Medical Device Manufacturing License Application. Cdph 72n - Cdph Ca

Filling out the New Medical Device Manufacturing License Application is an essential step for businesses looking to comply with regulations in California. This guide provides clear instructions on completing the application to ensure a smooth licensing process.

Follow the steps to successfully complete your application online.

1. Click ‘Get Form’ button to access the application form and open it for editing.
2. Enter the legal name of your firm in the designated field. This should be the full name of the business or organization applying for the license.
3. If applicable, provide any 'doing business as' (DBA) names in the corresponding section. Use a separate sheet if there are multiple DBAs.
4. Fill out the facility address with the number, street, city, state, and ZIP code. If there is a mailing address that differs from the facility location, include it in the following sections.
5. Complete the sections for the facility operator, including their name and title, telephone number, and fax number.
6. Input a 24-hour emergency telephone number and an email address where correspondence can be directed.
7. Identify the correspondent for inquiries regarding the application, providing their name, title, and contact information.
8. Select the county where the facility is located and include a website address if available.
9. Indicate your business's interstate commerce activities by marking the relevant boxes.
10. Specify the type of ownership your business has by selecting from the given options.
11. If applicable, provide the corporate name and the state of incorporation.
12. List the names and titles of the owners or officers of the business.
13. If previously licensed, include previous license numbers in the appropriate section.
14. Describe the type of manufacturing business, including facility size, number of employees, and business days and hours.
15. Check the box next to the stage of manufacture that corresponds to your products at the date of application.
16. Select all intended destinations for the manufactured devices by marking relevant checkboxes.
17. For the devices manufactured, check the applicable product areas as listed.
18. List the types of classified or unclassified devices in the space provided, including their federal classification titles.
19. Identify the manufacturing processes involved, indicating if they will be performed in-house or contracted out.
20. Select the appropriate payment code based on the application type, and include the corresponding fee.
21. Attach the required evidence of ownership and any necessary documents as outlined, ensuring to place checkmarks as appropriate.
22. Review the application thoroughly before signing it, ensuring all information is accurate and complete.
23. Provide your printed name, title, and date alongside your signature.
24. Once completed, save your changes, download the form, and prepare to print or share it as required.

Complete your application online to ensure compliance with California regulations.