Get Fda Form 484

Filling out the Fda Form 484 online is an important step for facilitating the proper handling and documentation of samples collected by FDA representatives. This guide provides clear instructions to ensure you accurately complete the form and meet all necessary requirements.

Follow the steps to fill out the Fda Form 484 online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Enter the district address and phone number in the designated fields, ensuring the information is accurate.
3. Fill in the name and title of the individual who is responsible for the sample collection.
4. Provide the date the form is being filled out.
5. Document the sample number in the specified section.
6. Complete the firm's name and DEA number accurately to ensure proper identification.
7. Enter the number and street for the firm’s address.
8. Fill in the city and state, including the zip code, for precise location identification.
9. Describe the sample collected fully, listing lot, serial, and model numbers for accurate identification.
10. Indicate how the samples were provided by selecting the appropriate option from the available choices.
11. Specify the amount received for the sample in the indicated field.
12. Print or type the collector’s name and title clearly.
13. Ensure the signature of the person receiving payment for the sample or who provided the sample is included.
14. Sign and date the form as the collector.
15. Review all information for accuracy, then save changes. You may download, print, or share the completed form as needed.

Complete your documents online now for a smoother submission process.