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U.S. DEPARTMENT OF AGRICULTURE 

FOOD SAFETY AND INSPECTION SERVICE 

APPLICATION FOR 

APPROVAL OF LABELS, 

MARKING OR DEVICE 

FSIS has determined that information provided 

in items 11, 15, and 16 is exempt from 

mandatory disclosure under the Freedom of 

Information Act 5 U.S.C. 552(b)(4). 

APPLICANT: See Page 5 for instructions. 

1. AGENT NAME, ADDRESS,

 TELEPHONE NO. (If using an Agent,

complete this block, otherwise leave 

blank.)

2. FOR USDA USE ONLY 3. FOR USDA USE ONLY 4. ESTABLISHMENT NO. / FOREIGN 

COUNTRY (If applicable) 

5a. NAME OF PRODUCT 

5b. HACCP PROCESS CATEGORY 6a. TYPE OF APPROVAL REQUESTED 

SKETCH TEMPORARY 

EXTENSION OF TEMPORARY 

7b. TOTAL AVAILABLE LABELING SPACE FOR ENTIRE PACKAGE (Square inches): 

8. Does this label include a "USDA-AMS Child Nutrition Program CN-Logo? Yes No

Certified/Verified 

10. Are there any special claims, guarantees, or foreign language on the label? YES NO (If yes, check all that apply)

Animal Production/Breed/Raising

Grading Terms

Nutrition/Health

Environmental/Green 

Allergen Statements

Religious Exemption

Export Only Labels w/deviations from Domestic Requirements

Geographic/Undefined Style

Guarantees

Foreign Language

Other Claims: Specify

9. (FOR USDA-AMS USE ONLY) CN Identification Number Assigned

FSIS FORM 7234-1 (11/16/2011) REPLACES FSIS FORM 7234-1 (09/01/2009), WHICH IS OBSOLETE. 

03J: Slaughter - all species

03B: Raw Product - ground

03C: Raw Product - not ground

03D: Thermally processed - commercially sterile 

03E: Not heat treated - shelf stable

03F: Heat treated - shelf stable

03G: Fully cooked - not shelf stable

03H: Heat treated but not fully cooked - not shelf stable 

03I: Product with secondary inhibitors - not shelf stable 

7a. AREA OF PRINCIPAL DISPLAY PANEL (Square Inches)

6b. WAS THE LABEL PREVIOUSLY APPROVED?

YES 

NO 

Date of approval: 

Prior approval number: 

Number of labels on hand: 

Number of days requested: 

11. NAME AND ADDRESS OF FIRM (Below and between dots) 

12. SIGNATURE OF APPLICANT OR AGENT 13. DATE

14. (FOR USDA USE ONLY) CONDITIONS APPLYING TO USE OF LABELS OR DEVICE

Natural/Organic

(Select one) 

► 

4a. TYPE OF PRODUCT

Egg Meat

Poultry Other
15. PRODUCT FORMULA PCT WEIGHT 

(No Fractions) 

TOTAL (Percent must total 100%) 

FSIS FORM 7234-1 (11/16/2011) page 2 PAGE of 

See Continuation Sheet
16. PROCESSING PROCEDURES (Approval of the sketch does not convey approval of the processing procedures) 

FSIS FORM 7234-1 (11/16/2011) page 3 PAGE of 

See Continuation Sheet
CONTINUATION SHEET FOR APPLICATION FOR APPROVAL OF LABELS, 

MARKING OR DEVICE (FSIS 7234-1)

PRODUCT NAME: 

PAGE of 

This sheet is being used for additional information required in Block(s): 

FSIS FORM 7234-1 (11/16/2011) page 4
INSTRUCTIONS FOR PREPARATION OF FSIS FORM 7234-1

Note: The following instructions should be typed unless otherwise noted. 

PREPARATION OF APPLICATION 

Submit two copies for each label application. 

Application must be typed or it will be returned without evaluation. 

B. TYPE OF APPROVAL REQUESTED 

Sketch: Self explanatory. (See 9 CFR 317.4 & 381.132) 

Temporary and Extension of Temporary. Actual label or color litho take off to be used. 

C. FOREIGN LANGUAGE

Labels printed in foreign languages must be accompanied by English language translation.

D. ASSEMBLY OF APPLICATION 

Application Form, Product Formula, Processing Procedures, Continuation Sheet if applicable, Label, 

and any Supporting Documentation Staple with one or as few staples as possible. (Do not use paper 

clips). 

E. MAIL COMPLETED APPLICATION TO: 

USDA, FSIS, OPPD, LPDD 

Labeling Distribution Unit

Stop Code 3786, Patriots Plaza III, 8-168

1400 Independence Avenue, SW

The following instructions relate to numbered items on form.

1. If using an Agent, provide the company name, address, and telephone number, 

otherwise leave blank. 

2 & 3. Leave blank, for USDA use only. 

4. Establishment No./Foreign Country (if applicable) - Self Explanatory. 

5a. Name of Product. Use common or descriptive product name, i.e., "Frankfurter , 

Cereal Added" or "Meat Patties in Gravy. (Do not use trade brand names or

coined names, such as "Joe's Corn Dogs" or "Joe's Sloppy Joes.") If coined 

names such as "Corn Dogs" are used, also show true product name, such as 

"Batter Wrapped Wiener." 

Provide HACCP process category for the product. See 9 CFR 417.2(b) (1), 

Example, Heat Treated - shelf stable, Not heat treated-shelf stable etc. Select one.

6a & b. Type of Approval Requested. If temporary approval or extension, insert 

number of days requested and number of labels on hand. If previous

approval, attach copy of application and label. Include specific reason(s)

why requesting a temporary or extension and include information required

in 9 CFR 317.4(f) (1) or 381.132(f) (1) on the continuation sheet. 

Be sure to include product name and block item. 

7a. Area of Principal Display Panel (PDP). The PDP is the entire side

of the package to which the label is affixed. See 9 CFR 317.2 (d)

and 381.116 (b).

A. 7b. Total available labeling space in square inches for entire package. 

8. USDA-AMS Child Nutrition Program Logo. Indicate if the product

includes a USDA-AMS Child Nutrition Program Logo.

9. Leave Blank. For USDA-AMS use only. 

10. Special claims, guarantees, or foreign language. Indicate if there are 

are any special claims, guarantees, or foreign language on the label.

Check all that apply. If Other Claims is selected, indicate specific claim(s) 

in space provided.

11. Name and Address of Firm. Insert Firm's name and mailing 

address. Use 2 letter symbol for State. Show postal zip code. 

12 & 13. Signature and Date of Applicant or Agent. To be signed and 

dated by the applicant or agent representing the official

establishment or plant.

14. 

Leave blank for USDA use only. Conditions Applying to Use of Label or 

Device. (Any condition, modification or remarks applied to the application 

when approved are conditions governing use of the approved devices.)

15. Product Formula. List the ingredients by percent or weight in order of 

their predominance. If product consists of several components, e.g., 

a frozen dinner, list each component separately and indicate the 

percentage or amount of each component in the product. If additional 

space is needed, check the box for "Continuation Sheet," and use the 

Continuation Sheet. Be sure to include the product name and number 

of the block item. Express all ingredients in the same units, i.e., do not 

list some in pounds and others in ounces.

Check whether weight or percent is used. It is preferred that 

percentages be used, and the total must equal 100 percent. If weights 

are used, show in pounds, kilograms or grams. (No gallons, pints, 

cups, teaspoons, etc.) The total must equal the weights of the 

individual units. (Example: Crust + Cheese + Sauce + Meat = Total 

new weight of unit.)

DO NOT use fractions. Express as decimals carried to two places, Example: 

1-1/4 lbs., show as 1.25 lbs. Example: 3/4 lbs., show as .75 lbs. 

16. Processing Procedures. Poultry Products provide complete 

processing procedures as required in 9 CFR 381.134. Meat 

Products, provide complete processing procedures as required. 

Note: Approval of the sketch does not convey approval of the 

processing procedures. If additional space is needed, check the box for 

"Continuation Sheet," and use the Continuation Sheet.

Be sure to include the product name and number of the block item. 

FSIS FORM 7234-1 (11/16/2011) 

5b.

Type of Product. Select one product type: Egg, Meat, Poultry, or Other (i.e. Exotic Species,

Non-Amenable, Voluntary, etc.)

4a.

Washington, DC 20250-3700