Reg 227 Form Details

Forms are an important part of any business. They help to establish guidelines, maintain accountability and ensure that all necessary information is collected in one place. The 227 form helps to collect contact information for visitors after they have completed a tour or visit at your museum. This blog will discuss how the 227 form can be improved on with some simple changes. The following paragraphs provide examples of ways to improve the 227 form: - Include a comment box so that visitors can leave feedback about their experience at your museum, this way you'll know what people think of your exhibits and be able to address it accordingly if needed.

We have compiled some statistical information about the 227 form. You might want to go through it just before completing the form.

QuestionAnswer
Form Name227 Form
Form Length1 pages
Fillable?Yes
Fillable fields66
Avg. time to fill out13 min 31 sec
Other names227 form fill, 227 form, 227 reregistration form, dhhs application substance act

Form Preview Example

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

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