Doh 2340 Form PDF Details

If you have to complete the Doh 2340 form, you're likely in the market for a new home. This comprehensive form is used by the Department of Housing and Urban Development (HUD) to determine if a property is eligible for federal housing assistance. In order to properly fill out the Doh 2340 form, it's important to understand its requirements and how to properly complete it. Our blog post can help walk you through the process.

QuestionAnswer
Form NameDoh 2340 Form
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesdoh 782 form, doh 2340 narcotic disposal fillable form, new york 2340 disposal, doh form 4329

Form Preview Example

NEW YORK STATE DEPARTMENT OF HEALTH Bureau of Narcotic Enforcement

Request for Approval of Disposal/Destruction of Controlled Substances

 

 

 

 

 

 

SECTION I – REQUEST INFORMATION

 

 

 

 

Office Use Only

3 Please use Adobe Acrobat to fill-in fields and save a copy on your computer.

 

LOG

NUMBER

3 Requests should be submitted to the applicable Bureau of Narcotic Enforcement office at

 

Approved

 

 

least 2 weeks prior to the proposed date of disposal/destruction.

 

 

 

 

 

 

 

 

3 Destruction must take place on a week day between 9 a.m. and 3 p.m. No weekends or holidays.

 

Partially Approved

 

3 Email submissions to BNE are preferred to bnedestruction@health.ny.gov

 

Denied

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Licensee Name

 

 

 

 

 

 

 

 

 

 

 

 

Comment(s)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Street*

 

 

 

 

 

 

 

 

*If using a P.O. Box,

 

 

 

 

 

 

 

 

 

 

 

 

 

 

a street address must

 

 

 

 

 

 

 

 

 

 

 

 

 

 

be included.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

City

 

 

 

State

Zip

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

County

 

 

 

Telephone

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Email Address

 

 

 

 

 

Fax

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Controlled Substance License #

 

Note: If the facility/program or individual is not subject to Article 33

 

 

 

 

 

 

 

 

 

controlled substance licensure, the applicable DEA registration number

 

 

 

 

 

 

 

 

 

should be entered.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Date of Disposal/Destruction

 

 

 

Start Time

 

 

 

 

Approved By

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

/

/

 

 

 

 

AM

 

PM

Name

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Method of Disposal/Destruction

Signature

Location of Disposal/Destruction (physical address) including room # or name

Date

PERSONNEL CONDUCTING DISPOSAL/DESTRUCTION

Name

Name

Title

 

Professional

 

 

License #

Title

 

Professional

 

 

License #

 

REQUESTOR AFFIRMATION

I hereby affirm that the controlled substances listed on the Controlled Substances Inventory Form (DOH-166) will be disposed of/destroyed as proposed in accordance with applicable federal, state and local laws. No controlled substances will be disposed of/destroyed without written permission of the New York State Department of Health’s Bureau of Narcotic Enforcement.

Name

 

 

Title

Signature

 

Date

SECTION II -- STATEMENT OF DISPOSAL/DESTRUCTION (to be completed following disposal/destruction)

We, the undersigned, affirm that the controlled substances listed on the Controlled Substances Inventory Form (DOH-166) were disposed of/destroyed on

/

/

as approved in accordance with applicable federal, state and local laws.

 

 

 

 

 

 

 

 

 

 

Name

Name

Signature

Signature

DISPOSAL/DESTRUCTION MUST BE COMPLETED EXACTLY AS PROPOSED.

NO SUBSTITUTIONS OF DATE, TIME, LOCATION OR PERSONNEL WILL BE PERMITTED

WITHOUT PRIOR APPROVALBY THE BUREAU OF NARCOTIC ENFORCEMENT.

DISPOSAL/DESTRUCTION ACTIVITIES MAY BE OBSERVED BY THE BUREAU OF NARCOTIC ENFORCEMENT. ALL CONTROLLED SUBSTANCES BEING DISPOSED OF OR DESTROYED ARE SUBJECT TO PHYSICAL INVENTORY.

DOH-2340 08/19

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A way to complete doh 2340 narcotic disposal fillable form step 1

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Find out how to fill out doh 2340 narcotic disposal fillable form portion 2

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