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Import
Export > DEA Form 161 -
Application for Permit to Export
Controlled Substances
DEA FORM 161
The application or declaration listed below
is available in PDF format in two ways – 1. As an interactive form
which can be completed on-line and printed on your printer, or 2. As
a blank form to be printed on your printer. This second version is not
recommended; fewer errors occur if the form is entered on-line and then
printed.
1
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Application for Permit to Export
Controlled Substances
Instructions
Privacy Act
INFORMATION AND INSTRUCTIONS, DEA-161
This application must be completed in triplicate. Original
is sent to DEA. See instruction 7 for copies two and three.
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The name and address of the consignee as shown on this
application and on the permit to export must correspond with that
shown on the foreign import certificate.
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To avoid delays in clearance at the port of export be
sure to enter the correct port on this application. A copy of your
export permit is sent directly to the District Director of
Customs at the port indicated on the application for comparison
with the permit presented for clearance of the shipment.
The shipment will not clear at any other port without an
amendment of the permit indicating a change to that
effect.
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The original or an authentic signed and/or notarized
copy of the foreign import certificate must accompany this application.
If this certificate is needed to accomplish entry of the
drug into the country of destination, your request for its return to
you should accompany the application.
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Application should be made in the name of the
registered legal entity, as shown on the DEA registration certificate, and
signed by a responsible authorized official if a
corporation, by a partner, or by the person registered as an individual.
Only
persons registered as exporters or as analytical
laboratories may be issued export permits. The registrations of
manufacturers, distributors, practitioners, researchers,
etc., do not entitle them to export controlled substances.
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Permits will be mailed to the exporter at the address
shown at the bottom of the application unless contrary instructions
are attached to and made a part of this application.
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Identification of drugs to be exported and the
controlled substance content should be entered on the application in the
following manner:
7a. NAME AND QUANTITY OF DRUG OR PREPARATION
TO BE EXPORTED
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7b. CONTROLLED SUBSTANCE CONTENT OF DRUG OR PREPARATION TO BE EXPORTED (expressed
as acid, base or alkaloid, not salt)
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3 bottles x 100 Secobarbital Sodium capusules (100
mg./capsule)
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secobarbital
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27.47 gm
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2 boxes x 100 Meperidine HCl ampules (5%, 2 ml. ampules)
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meperidine
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17.43 gm
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1 box x 100 Meperidine HCl vials (10%, 20 ml., vials)
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meperidine
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174.30 gm
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2 x 1 Pt. Meperidine HCl Syrup (50 mg./5 ml., pints)
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meperidine
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8.24 gm
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1 box x 100 gm. Detroamphetamine Sulfate powder
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dextroamphetamine
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73.38 gm
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1 bottle x 500 Hydromorphone HCl tablets (4 mg./tablets)
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hydromorphone
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1.77 gm
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The following information must be entered in block 7c
at the time of export: (1) DEA Export Permit Number and (2) actual quantity and date shipped. Copy 2 is sent
to DEA, and Copy 3 is retained by the registrant.
PRIVACY ACT INFORMATION
Authority: Section 1003 of the Controlled Substances
Act of 1970 (PL 91-513).
Purpose: Control exportation of certain Controlled
Substances into the United States.
Routine Uses: The Controlled Substances Act
Registration Records produces special reports required for statistical
analytical purposes. Disclosures of information from this system are made
to the following categories of users for the purposes stated:
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Other Federal law enforcement and regulatory agencies
for law enforcement and regulatory purposes.
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State and local law enforcement and regulatory agencies
for law enforcement and regulatory purposes.
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Persons registered under the Controlled Substances Act
(Public Law 91-513) for purposes of verifying the registration of customers and practitioners.
Effect: No permit will be issued.
Under the Paperwork Reduction Act, a person is not
required to respond to a collection of information unless it displays a
currently valid OMB control
number. Public reporting burden for this collection of
information is estimated to average 15 minutes per response, including the
time for reviewing
instructions, searching existing data sources, gathering
and maintaining the data needed, and completing and reviewing the
collection of information.
Send comments regarding this burden estimate or any other
aspect of this collection of information, including suggestions for
reducing this burden,
to the FOI and Records Management Section, Drug
Enforcement Administration, Washington, D.C. 20537; and to the Office of
Management and Budget, Paperwork Reduction Project No. 1117-0004,
Washington, D.C. 20503.
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