227 Form PDF Details

Form DHHS 227 is used by businesses and institutions in North Carolina to apply for reregistration under the Controlled Substances Act of 1971. Any entity that manufactures, distributes, researches, or handles controlled substances must complete this form to keep its state authorization active.

Businesses that must file the 227 form include manufacturers, distributors, wholesale distributors, importers and exporters, dispensers, analytical laboratories, researchers, and dog handlers. Each business category has its own registration fee and applies to specific drug schedules. Applicants must also list all drug code numbers relevant to their operations on the form.

The form requires applicants to declare their authorization under both state and federal law. Any prior legal infractions that might affect eligibility must be disclosed. If a previous registration was denied or revoked, the applicant must attach a written explanation. The completed form and payment are mailed to the NC DHHS Controller's Office.

If you work with controlled substances in North Carolina, you may also need related compliance forms. Review the DHHS 2089 form, the DHHS 2124 form, and the DHHS incident report for additional requirements. Facilities that track medications should also keep a controlled drug log.

QuestionAnswer
Form Name227 Form
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other names227 form printable, 227 form print, 227 reregistration form, 227 form pdf

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FORM DHHS 227

Application for Reregistration

under

N.C. Controlled Substances Act

of 1971

DHHS Registration No. ___________________

DEA No. ___________________

Please print or type all entries

____________________________________________________

Name of Applicant (Facility Name)

_________________________________________________________

Mailing Address

_________________________________________________________

Location

_________________________________________________________

TownCountyStateZip

Applicant Telephone: ___________________________________________

Area Code

Point of Contact Name: ________________________

Point of Contact Telephone: _____________________

RETAIN COPY

Mail Application to:

Department of Health and Human Services

Controller’s Office-Accounts Receivable

2025 Mail Service Center

Raleigh, North Carolina 27699-2025

Telephone: (919) 733-1765

REGISTRATION CLASSIFICATION: SUBMIT CHECK OR MONEY ORDER PAYABLE TO: SUBSTANCE ABUSE DRUG REGULATORY

1. Business Activity: (Check one only)

A

Manufacturer $600

B

Distributor $500

C

Researcher $125

D

Analytical Laboratory $100

E

Dog Handler $150

2.Drug Schedules: (Check all applicable)

Schedule I

Schedule II

 

Narcotic

Schedule IIN Non-narcotic

Schedule III

Narcotic

Schedule IIIN Non-narcotic

Schedule IV

Schedule V

Schedule VI

3.Registration as a manufacturer conveys distribution privileges only as those substances manufactured.

Manufacturers (Item 1A, Business Activity) check schedules applicable to any category in the boxes below:

 

 

Schedules

 

 

I

II

III

IV

V

VI

Bulk Manufacturer

 

 

 

 

 

Synthesizer-Extractor

 

 

 

 

 

Dosage Form

 

 

 

 

 

Manufacturer

 

 

 

 

 

Repacker-Relabeler

4.ALL APPLICANTS MUST ANSWER THE FOLLOWING:

(a)Are you currently authorized to manufacture, distribute, dispense, prescribe, conduct research, or otherwise handle the controlled substances in the schedules for which you applying under the laws of North Carolina or the Federal Government?

Yes

No

(b)Has the applicant been convicted of a felony under State or Federal law relating to the manufacture, possession, distribution, or dispensing of controlled substances?

Yes No

(c)Has any previous registration held by the applicant, corporation, firm, partner, or officer of applicant under Federal CSA or NCCSA been surrendered, revoked, suspended, denied, or is it pending such action?

Yes

No

If YES to b and/or c, attach a letter setting forth the circumstances of such action.

5. Drug code numbers must coincide with the schedules requested, listed below are the drug code requirements for each business activity:

Analytic Lab – Not Required To List Drug Codes

Distributor – Schedule I

Researcher – Schedule I, II, III, IV, V and VI

Manufacturer – Schedule I, II, III, IIIN

IF ADDITIONAL SPACE IS REQUIRED, USE A SEPARATE SHEET AND RETURN WITH APPLICATION

AUTHORIZED INDIVIDUAL

 

 

 

__________________

________________________________

_________________________________

______________________________

Date

Print or Type Name

Signature

Official Title

How to Edit 227 Form Online for Free

Our free PDF editor makes it easy to fill out the 227 form online. Follow these steps to complete your DHHS 227 form.

Step 1: Click the orange "Get Form Now" button on this page to open the 227 form in our PDF editor.

Step 2: Use the editing toolbar to fill in the required fields. You can add text, erase content, highlight sections, and adjust any part of the form.

Complete all required fields on the 227 form:

example of blanks in 227 form

Enter your business type, applicable drug schedules (III, IV, V, VI), drug code numbers, and registration fee category. Indicate whether any previous registration has been denied or revoked. Bulk manufacturers and repackagers must list all drug code numbers. Sign and date the form in the authorized individual section.

Completing 227 form step 2

Step 3: Click "Done" to save your completed 227 form. Download it to your device or send it by email.

Step 4: Print the completed DHHS 227 form and mail it with your registration fee to the NC DHHS Controller's Office.

Who Needs to Complete the 227 Form?

The 227 form is required for any North Carolina business or institution that handles controlled substances under the state Controlled Substances Act. This includes manufacturers, wholesale distributors, analytical laboratories, dispensers, researchers, importers, exporters, and dog handlers. Each category has its own applicable drug schedules and registration fee.

What Information Does the DHHS 227 Form Require?

You will need your business name and address, your federal registration number, the applicable drug schedules for your operations, and a complete list of drug code numbers. You must also declare your authorization under both state and federal law and disclose any prior legal infractions that may affect eligibility.

Where Do You Submit the 227 Form?

Mail the completed DHHS 227 form with your check or money order to the NC Department of Health and Human Services Controller's Office at 2035 Mail Service Center, Raleigh, NC 27699-2035. Registration fees vary by business category and drug schedule.

How Often Must You File the 227 Form?

The DHHS 227 form is a reregistration form, meaning it must be filed periodically to renew your controlled substance authorization. Check your current registration expiration date and submit the form before it lapses to avoid any gap in your authorization to handle controlled substances.

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