This form is for reporting lost or stolen controlled substances. Do not use this form if:

1. You have not previously registered with the DEA.
2. The loss or theft you are reporting is not for a controlled substance.
3. You want to correct minor inventory shortages.

This on-line version of Form DEA 106 has ten sections. What follows is a description of each section and the information you will need to successfully fill out this on-line form. Please note that on all pages where you are required to supply information, there is a section labelled Help. For any field on the page for which you require clarification, place the cursor in the field and click. Help text describing the field will appear in the Help section.

  Section 1.  Authentication:
You will be asked to enter your DEA Number and your last name or the business name you used to register with the DEA. The name you supply must match exactly the name on your registration.
  Section 2.  Background Information:
You will be asked to provide background information relating to this lost or theft incident, eg. the date and place, the type (night break-in, armed robbery, etc.), the estimated value of the controlled substances, etc.
  Section 3.  Additional Background Information (Optional):
Your answers in Section 2 will determine whether or not you will be required to provide additional details in this section. For example, if you indicated in Section 2 that a police report was filed, you will be asked to provide the name and telephone number of the police department. It is possible that your replies in Section 2 do not warrant further details, in which case this section will not appear.
  Section 4.  Controlled Substances, Part 1:
You will be asked to pick from a list the common name of the controlled substance that was lost or stolen and the dosage form (bottle, powder, capsule, etc). If the controlled substance does not appear in the list, you can enter it manually.
  Section 5.  Controlled Substances, Part 2:
In this section you will provide details of the controlled substance you selected in Section 4, e.g. dosage strength, container size, units lost or stolen, etc.
  Section 6.  Controlled Substances Recap:
You may report one or more controlled substances per loss / theft incident. This section gives you a chance to repeat Sections 4 and 5 in order to report additional controlled substances. Alternatively, you may continue to Section 7.
  Section 7.  Signature:
You will be asked to supply the name and title of the person filing this report.
  Section 8.  Summary, Part 1:
The data you entered in Sections 2 and 3 is presented for your review. You will be given an opportunity to make any corrections.
  Section 9.  Summary, Part 2:
The data you entered in Sections 4 and 5 is presented for your review. You will be given an opportunity to make any corrections. You may also revisit Section 8. Once you have reviewed and ascertained that the information in all Sections is correct, you can submit the report. Please note that once the report is submitted, you will be provided information that will allow the report to be amended using this tool. Please save this information in a secure location to allow for easy access to the amendment feature.
  Section 10.  Print:
In this section you will be able to output a copy of the report to your local printer. DEA regulations specify that you keep a copy of this report for two years. Please see the DEA's rules clarification.

WARNING: Section 843(a)(4)(A) of Title 21, United States Code, states that any person who knowingly or intentionally furnishes false or fraudulent information in the application is subject to imprisonment for not more than four years, a fine of not more that $30,000.00 or both.