(Date) _______________________________
Dockets Management Staff, Food and Drug Administration, Department of Health and Human Services, 5630 Fishers Lane, rm. 1061, Rockville, MD 20852.
Request for Advisory Opinion
The undersigned submits this request for an advisory opinion of the Commissioner of Food and Drugs with respect to ______ (the general nature of the matter involved).
(A concise statement of the issues and questions on which an opinion is requested.)
(A full statement of all facts and legal points relevant to the request.)
The undersigned certifies that, to the best of his/her knowledge and belief, this request includes all data, information, and views relevant to the matter, whether favorable or unfavorable to the position of the undersigned, which is the subject of the request.
(Signature) _______________________________
(Person making request) _______________________________
(Mailing address) _______________________________
(Telephone number)_______________________________
21 C.F.R. §10.85