(Date) _______________________________
Dockets Management Staff, Food and Drug Administration, Department of Health and Human Services, rm. 1-23, 5630 Fishers Lane, rm. 1061, Rockville, MD 20852.
Petition for Reconsideration
[DOCKET NO.]
The undersigned submits this petition for reconsideration of the decision of the Commissioner of Food and Drugs in Docket No. ____.
(A concise statement of the decision of the Commissioner which the petitioner wishes to have reconsidered.)
(The decision which the petitioner requests the Commissioner to make upon reconsideration of the matter.)
(A full statement, in a well-organized format, of the factual and legal grounds upon which the petitioner relies. The grounds must demonstrate that relevant information and views contained in the administrative record were not previously or not adequately considered by the Commissioner.
(No new information or views may be included in a petition for reconsideration.)
(Signature) _______________________________
(Name of petitioner) _______________________________
(Mailing address) _______________________________
(Telephone number)_______________________________
21 C.F.R. §10.33