Form 225 PDF Details

Navigating the complexities of the Controlled Substances Act (CSA) often culminates in the encounter with Form DEA-225, an essential vehicle for entities aiming to lawfully engage with controlled substances. This form serves as a beacon for researchers, manufacturers, distributors, and others by delineating the procedural roadmap for registration under the CSA. The detailed sections of the form intricately lay out the necessities — from applicant identification to business activities, schedules, and drug codes. It mandates specific attention to liability questions, a consequential area given the legal and ethical ramifications tied to controlled substance management. Moreover, the division regarding state licenses underscores the dual necessity of adhering to both federal and state regulatory frameworks — a symbiotic legal relationship often navigated with caution. The financial aspect, as indicated by the non-refundable fees, the option for exemption, and the explicit instruction for selecting a payment method, alongside the solemn declaration required in the applicant’s signature, concretizes the formal engagement with the DEA. The form not only facilitates compliance with regulatory mandates but also embodies the multifaceted considerations spanning legal statutes, ethical considerations, and administrative logistics integral to controlled substance research, distribution, or manufacturing.

QuestionAnswer
Form NameForm 225
Form Length4 pages
Fillable?No
Fillable fields0
Avg. time to fill out1 min
Other namesdea, dea 225 form 225 substance, form 225 application, form 225 application control substance

Form Preview Example

Form-225

APPLICATION FOR REGISTRATION

 

Under the Controlled Substances Act

APPROVED OMB NO 1117-0012

FORM DEA-225 (04-12)

FORM EXPIRES: 9/30/2021

INSTRUCTIONS

Save time - apply on-line at www.deadiversion.usdoj.gov

1.

To apply by mail complete this application. Keep a copy for your records.

 

 

2.

Mail this form to the address provided in Section 7 or use enclosed envelope.

 

3.

The "MAIL-TO ADDRESS" can be different than your "PLACE OF BUSINESS" address.

 

4.

If you have any questions call 800-882-9539 prior to submitting your application.

 

IMPORTANT: DO NOT SEND THIS APPLICATION AND APPLY ON-LINE.

 

 

MAIL-TO ADDRESS

Please print mailing address changes to the right of the address in this box.

DEA OFFICIAL USE:

Do you have other DEA registration numbers?

NO

YES

FEE FOR ONE (1) YEAR - see Section 2

FEE IS NON-REFUNDABLE

SECTION 1 APPLICANT IDENTIFICATION

Individual Registration

Business Registration

Name 1 (Last Name of individual -OR- Business or Facility Name)

Name 2 (First Name and Middle Name of individual - OR- Continuation of business name)

PLACE OF BUSINESS Street Address Line 1

PLACE OF BUSINESS Address Line 2

City

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

State

Zip Code

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Business Phone Number

 

Point of Contact

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Business Fax Number

 

Email Address

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DEBT COLLECTION INFORMATION Mandatory pursuant to Debt Collection Improvements Act

Tax Identification Number (if registration is for business)

Provide TIN or SSN. See additional information note #3 on page 4.

Social Security Number (if registration is for individual)

SECTION 2

BUSINESS ACTIVITY

Check one business activity box only

Researcher - See page 4 for required attachments

Analytical Lab

fee for one year is $244

Researcher w/Sched I

fee for one year is $244

Researcher w/Sched II - V

fee for one year is $244

Canine Handler

fee for one year is $244

Distributor

fee for one year is $1523

Exporter

fee for one year is $1523

Importer

fee for one year is $1523

Reverse Distributor

fee for one year is $1523

Manufacturer

fee for one year is $3047

Manufacturer BULK

fee for one year is $3047

SECTION 3

A. DRUG SCHEDULES

Check all that apply

Enter drug codes on page 2.

manufacturers &

 

 

Schedule 3

Narcotic

List 1 (L1) ­ importers ONLY

Schedule 2

Narcotic

Schedule 1

Schedule 2

Non-Narcotic (2N)

Schedule 3

Non-Narcotic (3N)

Check this box if you require official order forms - for purchase of schedule 2 controlled substances.

Schedule 4 Schedule 5

B.MANUFACTURERS ONLY

Mark each box with an 'X' to indicate which drug schedule is handled in each manufacturing stage

L1 1 2 2 NON 3 3 NON 4 5

narcotic narcotic

L1 1 2 2 NON 3 3 NON 4 5

narcotic narcotic

STAGE 1

Bulk synthesis/extraction

STAGE 2

Dosage form manufacture

L1 1 2 2 NON 3 3 NON 4 5

narcotic narcotic

L1 1 2 2 NON 3 3 NON 4 5

narcotic narcotic

STAGE 3

Package / Repackage

Label / Relabel

STAGE 4 Non-human consumption

NEW - Page 1

SECTION 4

STATE LICENSE(S)

You MUST be currently authorized to prescribe, distribute, dispense, conduct research, or otherwise handle the controlled substances in the schedules for which you are applying under the laws of the state or jurisdiction in which you are operating or propose to operate.

Be sure to include both state license numbers if applicable

State License Number

(REQUIRED)

What state issued this license ?

State Controlled Substance

License Number

(if required)

What state issued this license ?

Expiration

/

/

Date

 

 

(REQUIRED)

MM - DD - YYYY

 

Expiration

/

/

Date

 

 

(if required)

MM - DD -

YYYY

SECTION 5

LIABILITY

IMPORTANT

All questions in this section must be answered.

1.Has the applicant ever been convicted of a crime in connection with controlled substance(s) under state or federal law, or been excluded or directed to be excluded from participation in a medicare or state health care program, or is any such action pending?

Date(s) of incident MM-DD-YYYY:

2.Has the applicant ever surrendered (for cause) or had a federal controlled substance registration revoked, suspended, restricted, or denied, or is any such action pending?

Date(s) of incident MM-DD-YYYY:

3.Has the applicant ever surrendered (for cause) or had a state professional license or controlled substance registration revoked, suspended, denied, restricted, or placed on probation, or is any such action pending?

YES NO

YES NO

YES NO

Date(s) of incident MM-DD-YYYY:

 

 

 

 

 

 

 

 

 

 

 

YES NO

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4. If the applicant is a corporation (other than a corporation whose stock is owned and traded by the public), association,

 

partnership, or pharmacy, has any officer, partner, stockholder, or proprietor been convicted of a crime in connection with

 

controlled substance(s) under state or federal law, or ever surrendered, for cause, or had a federal controlled substance

 

registration revoked, suspended, restricted, denied, or ever had a state professional license or controlled substance

 

registration revoked, suspended, denied, restricted or placed on probation, or is any such action pending?

 

Date(s) of incident MM-DD-YYYY:

 

 

 

 

 

 

 

 

 

 

Note: If question 4 does not apply to you, be sure to mark 'NO'.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

It will slow down processing of your application if you leave it blank.

 

 

 

 

 

 

 

 

 

 

EXPLANATION OF "YES" ANSWERS

Applicants who have answered "YES" to any of the four questions above must provide

a statement to explain each "YES" answer.

Use this space or attach a separate sheet and return with application

Liability question #

 

Location(s) of incident:

Nature of incident:

Disposition of incident:

SECTION 6 EXEMPTION FROM APPLICATION FEE

Check this box if the applicant is a federal, state, or local government official or institution. Does not apply to contractor-operated institutions.

Business or Facility Name of Fee Exempt Institution. Be sure to enter the address of this exempt institution in Section 1.

The undersigned hereby certifies that the applicant named hereon is a federal, state or local government official or institution, and is exempt from payment of the application fee.

FEE EXEMPT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CERTIFIER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Signature of certifying official (other than applicant)

 

 

 

 

 

 

 

 

 

 

 

 

Date

Provide the name and

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

phone number of the

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Print or type name and title of certifying official

 

 

 

 

 

 

 

 

 

 

 

 

Telephone No. (required for verification)

certifying official

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SECTION 7

Check

Make check payable to: Drug Enforcement Administration

 

 

 

 

 

 

See page 4 of instructions for important information.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

METHOD OF

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Mail this form with payment to:

PAYMENT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

American Express

 

Discover

 

Master Card

Visa

 

 

 

 

 

 

 

 

 

 

 

 

 

Check one form of

Credit Card Number

 

 

 

 

 

 

 

 

 

 

 

 

 

Expiration Date

 

 

 

DEA Headquarters

payment only

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ATTN: Registration Section/ODR

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

P.O. Box 2639

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Springfield, VA 22152-2639

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Sign if paying by

Signature of Card Holder

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

FEE IS NON-REFUNDABLE

credit card

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Printed Name of Card Holder

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SECTION 8

I certify that the foregoing information furnished on this application is true and correct.

 

 

 

 

 

APPLICANT'S

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SIGNATURE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Signature of applicant

(sign in ink)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Date

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Sign in ink

Print or type name and title of applicant

WARNING: 21 USC 843(d), states that any person who knowingly or intentionally furnishes false or fraudulent information in the application is subject to a term of imprisonment of not more than 4 years, and a fine under Title 18 of not more than $250,000, or both.

NEW - Page 3

C. SCHEDULE AND DRUG CODES

Listed below are examples of schedules 1-5 and List 1 codes. Check all drug codes you handle as required.

For more information, see our website at www.deadiversion.usdoj.gov, 21 CFR 1308, or call 1-800-882-9539.

Canine Handler

must mark schedule 1

Distributor

must mark all schedule 1, drug code 2012

Exporter

must mark all schedule 1-5

Reverse Distributor

must mark all schedule 1, drug code 2012

Importer

must mark all schedule 1-5 & List 1 codes

Researcher w/Sched 1

must mark schedule 1

Manufacturer

must mark all schedule 1, 2 & List 1 codes

Researcher w/Sched 2-5

must mark schedule 2 to be manufactured or imported

 

 

 

as part of research

If you bulk manufacture a substance, check the 'BULK?' column after the applicable class code.

SCHEDULE 1 NARCOTIC & NON-NARCOTIC

CODE

BULK?

 

SCHEDULE 2 NARCOTIC & NON-NARCOTIC

CODE

BULK?

 

 

3,4-Methylenedioxyamphetamine (MDA)

7400

 

 

 

Amobarbital (Amytal, Tuinal)

2125

 

 

3,4-Methylenedioxymethamphetamine (MDMA)

7405

 

 

 

Amphetamine (Dexedrine, Adderall)

1100

 

 

4-Methyl - 2,5 - Dimethoxyamphetamine (DOM, STP)

7395

 

 

 

Cocaine (Methyl benzoylecgonine)

9041

 

 

4-Methylaminorex (cis isomer) (U4Euh, McN-422)

1590

 

 

 

Codeine (Morphine methyl ester)

9050

 

 

Alphacetylmethadol (except LAAM)

 

9603

 

 

 

Dextropropoxyphene (bulk)

9273

 

 

Bufotenine (Mappine)

 

7433

 

 

 

Diphenoxylate

9170

 

 

Marihuana / Cannabidiol

 

7360

 

 

 

Fentanyl (Duragesic)

9801

 

 

Diethyltryptamine (DET) (

 

7434

 

 

 

Hydrocodone (Dihydrocodeinone)

9193

 

 

Difenoxin 1MG/25UG AtSO4 /DU (Motofen)

9167

 

 

 

Hydromorphone (Diaudid)

9150

 

 

Dimethyltryptamine (DMT)

 

7435

 

 

 

Levo-Alphacetylmethadol (LAAM)

9648

 

 

Etorphine (except HCL)

 

9056

 

 

 

Levorphanol (Levo-Dromoran)

9220

 

 

Gamma Hydroxybutyric Acid (GHB)

 

2010

 

 

 

Meperidine (Demerol, Mepergan)

9230

 

 

Heroin (Diamorphine)

 

9200

 

 

 

Methadone (Dolophine, Methadose)

9250

 

 

Ibogaine

 

7260

 

 

 

Methamphetamine (Desoxyn)

1105

 

 

Lysergic acid diethylamide (LSD)

 

7315

 

 

 

Methylphenidate (Concerta, Ritalin)

1724

 

 

Mescaline

 

7381

 

 

 

Morphine (MS Contin, Roxanol)

9300

 

 

Marihuana

 

7360

 

 

 

Opium, powdered

9639

 

 

Methaqualone (Quaalude)

 

2565

 

 

 

Oxycodone (Oxycontin, Percocet)

9143

 

 

Normorphine

 

9313

 

 

 

Oxymorphone (Numorphan)

9652

 

 

Peyote

 

7415

 

 

 

Pentobarbital (bulk) (Nembutal)

2270

 

 

Psilocybin

 

7437

 

 

 

Phencyclidine (PCP)

7471

 

 

Tetrahydrocannabinols (THC)

 

7370

 

 

 

Secobarbital (Seconal, Tuinal)

2315

 

SCHEDULE 3 NARCOTIC & NON-NARCOTIC

CODE

BULK?

 

SCHEDULE 4 NARCOTIC & NON-NARCOTIC

CODE

BULK?

 

Anabolic Steroids

 

4000

 

 

 

Alprazolam (Xanax

2882

 

 

Barbituric acid derivative

 

2100

 

 

 

Barbital (Veronal, Plexonal)

2145

 

 

Benzphetamine (Didrex, Inapetyl)

 

1228

 

 

 

Chloral Hydrate (Noctec)

2465

 

 

Buprenorphine (Buprenex, Temgesic)

 

9064

 

 

 

Chlordiazepoxide (Librium)

2744

 

 

Butabarbital

 

2100

 

 

 

Clonazepam (Klonopin)

2737

 

 

Butalbital

 

2100

 

 

 

Clorazepate (Tranxene)

2768

 

 

Codeine combo product (Empirin)

 

9804

 

 

 

Diazepam (Valium)

2765

 

 

Dihydrocodeine combo product (Compal)

9807

 

 

 

Flurazepam (Dalmane)

2767

 

 

Dronabinol in sesame oil soft cap (Marinol)

7369

 

 

 

Lorazepam (Ativan)

2885

 

 

Gamma-Hydroxybutyric Acid preparations (Zyrem)

2012

 

 

 

Meprobamate (Milltown, Equanil)

2820

 

 

Hydrocodone combo products (Lorcet, Vicodin)

9806

 

 

 

Midazolam (Versed)

2884

 

 

Ketamine (Ketaset, Ketalar)

 

7285

 

 

 

Oxazepam (Serax, Serenid-D)

2835

 

 

Morphine combo product

 

9810

 

 

 

Phenobarbital (Fastin, Zantryl)

2285

 

 

Nalorphine (Nalline)

 

9400

 

 

 

Phentermine

1640

 

 

Opium combo product (Paregoric)

 

9809

 

 

 

Temazepam (Restoril)

2925

 

 

Pentobarbital suppository dosage (FP3)

 

2270

 

 

 

Zolpidem (Ambien, Stilnox)

2783

 

 

Phendimetrazine (Plegine, Bontril)

 

1615

 

 

LIST 1 REGULATED CHEMICALS

CODE

BULK?

 

Thiopental

 

2100

 

 

** ONLY manufacturers & importers may select List 1

 

 

 

 

 

 

 

 

 

 

SCHEDULE 5 NARCOTIC & NON-NARCOTIC

CODE

BULK?

 

 

Ephedrine

8113

 

 

Codeine preparations (Robitussin A-C, Pediacof)

9050

 

 

 

Phenylpropanolamine

1225

 

 

Pyrovalerone (Centroton, Thymergix)

 

1485

 

 

 

Pseudoephedrine

8112

 

WRITE IN ADDITIONAL CODES

You may write in additional drug codes in this section. Attach a separate sheet if needed.

 

 

NEW - Page 2

Form-225

APPLICATION FOR REGISTRATION

Supplementary Instructions and Information

SECTION 1. APPLICANT IDENTIFICATION - Information must be typed or printed in the blocks provided to help reduce data entry errors. A physical address is required in address line 1; a post office box or continuation of address may be entered in address line 2. Fee exempt applicant must list the address of the fee exempt institution. Applicant must enter a valid social security number (SSN), or a tax identification number (TIN) if applying as a business entity.

Debt collection information is mandatory pursuant to the Debt Collection Improvement Act of 1996.

SECTION 2. BUSINESS ACTIVITY - Indicate only one. Each type of business activity requires a separate application. You are required to register as a "manufacturer" if you manufacture a controlled substance or list 1 chemical and then distribute it.

SECTION 3A. SCHEDULES - Applicant should check all schedules to be handled. However, applicant must still comply with state requirements; federal registration does not overrule state restrictions. Check the order form box only if you intend to purchase or to transfer schedule 1 and 2 controlled substances. Order forms will be mailed to the registered address following issuance of a Certificate of Registration.

3B. MANUFACTURER ONLY - Mark the chemical/controlled substance schedule(s) handled in each manufacturing stage listed.

3C. SCHEDULE CODES - Report all chemical/drug codes as required for your business activity. Controlled substances manufacturers and importers must obtain a separate chemical registration if they handle chemicals other than an FDA-approved drug product containing 1225, 8112, or 8113.

SECTION 4. STATE LICENSE(S) - Federal registration by DEA is based upon the applicant's compliance with applicable state and local laws. Applicant should contact the local state licensing authority prior to completing this application. If your state requires a license, provide that number on this application.

SECTION 5. LIABILITY - Applicant must answer all four questions for the application to be accepted for processing. If you answer "Yes" to a question, provide an explanation in the space provided. If you answer "Yes" to several questions, then you must provide a separate explanation describing the date, location, nature, and result of each incident. If additional space is required, you may attach a separate page.

SECTION 6. EXEMPTION - Exemption from payment of application fee is limited to federal, state or local government official or institution. The applicant's superior or agency officer must certify exempt status. The signature, authority title, and telephone number of the certifying official (other than the applicant) must be provided. The address of the fee exempt institution must appear in Section 1.

SECTION 7. METHOD OF PAYMENT - Indicate the desired method of payment. Make checks payable to "Drug Enforcement Administration". Third-party checks or checks drawn on foreign banks will not be accepted. FEES ARE NON-REFUNDABLE.

SECTION 8. APPLICANT'S SIGNATURE - Applicant MUST sign in this section or application will be returned. Card holder signature in section 7 does not fulfill this requirement.

ATTACHMENTS: Researcher or canine handler must attach 3 copies of protocol, including curriculum vitae, to conduct research with schedule 1 controlled substances. For clinical investigations, researcher must first submit to FDA a "Notice of Claimed Investigational Exemption for New Drug (IND)". See DEA web site or CFR 1301.18 for details.

NOTICE TO REGISTRANTS MAKING PAYMENT BY CHECK

Authorization to Convert Your Check: If you send us a check to make your payment, your check will be converted into an electronic fund transfer. "Electronic fund transfer" is the term used to refer to the process in which we electronically instruct your financial institution to transfer funds from your account to our account, rather than processing your check. By sending your completed, signed check to us, you authorize us to copy your check and to use the account information from your check to make an electronic fund transfer from your account for the same amount as the check. If the electronic fund transfer cannot be processed for technical reasons, you authorize us to process the copy of your check.

Insufficient Funds: The electronic funds transfer from your account will usually occur within 24 hours, which is faster than a check is normally processed. Therefore, make sure there are sufficient funds available in your checking account when you send us your check. If the electronic funds transfer cannot be completed because of insufficient funds, we may try to make the transfer up to two more times.

Transaction Information: The electronic fund transfer from your account will be on the account statement you receive from your financial institution. However, the transfer may be in a different place on your statement than the place where your checks normally appear. For example, it may appear under "other withdrawals" or "other transactions". You will not receive your original check back from your financial institution. For security reasons, we will destroy your original check, but we will keep a copy of the check for record-keeping purposes.

Your Rights: You should contact your financial institution immediately if you believe that the electronic fund transfer reported on your account statement was not properly authorized or is otherwise incorrect. Consumers have protections under Federal law called the Electronic Fund Transfer Act for an unauthorized or incorrect electronic fund transfer.

ADDITIONAL INFORMATION

No registration will be issued unless a completed application form has been received (21 CFR 1301.13).

In accordance with the Paperwork Reduction Act of 1995, no person is required to respond to a collection of information unless it displays a valid OMB control number. The OMB number for this collection is 1117-0012. Public reporting burden for this collection of information is estimated to average 12 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the information.

The Debt Collection Improvements Act of 1996 (31 U.S.C. §7701) requires that you furnish your Taxpayer Identification Number (TIN) or Social Security Number (SSN) on this application. This number is required for debt collection procedures if your fee is not collectible.

PRIVACY ACT NOTICE: Providing information other than your SSN or TIN is voluntary; however, failure to furnish it will preclude processing of the application. The authorities for collection of this information are §§302 and 303 of the Controlled Substances Act (CSA) (21 U.S.C. §§822 and 823). The principle purpose for which the information will be used is to register applicants pursuant to the CSA. The information may be disclosed to other Federal law enforcement and regulatory agencies for law enforcement and regulatory purposes, State and local law enforcement and regulatory agencies for law enforcement and regulatory purposes, and person registered under the CSA for the purpose of verifying registration. For further guidance regarding how your information may be used or disclosed, and a complete list of the routine uses of this collection, please see the DEA System of Records Notice "Controlled Substances Act Registration Records" (DEA-005), 52 FR 47208, December 11, 1987, as modified.

Your Local

CONTACT INFORMATION

DEA Office

All offices are listed on web site

 

 

(800, 877, and 888 are toll-free

INTERNET:

www.deadiversion.usdoj.gov

TELEPHONE:

HQ Call Center (800) 882-9539

WRITTEN INQUIRIES:

DEA

Attn: Registration Section/ODR

P.O. Box 2639

Springfield, VA 22152-2639

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