Drug Registration > PDF Forms > DEA Form 510 Instructions

Registration Applications

DEA Form 510 - Domestic Chemicals
New Application for Registration - Instructions

• SECTION 1. APPLICANT IDENTIFICATION

• SECTION 2. BUSINESS ACTIVITY

• SECTION 3. SCHEDULES

  • Manufacturer Only

  • Chemical Codes

• SECTION 4. STATE LICENSE(S)

• SECTION 5. LIABILITY

• SECTION 6. EXEMPTION

• SECTION 7. METHOD OF PAYMENT

• SECTION 8. APPLICANT SIGNATURE

• NOTICE TO REGISTRANTS PAYING BY CHECK

• CONTACT INFORMATION

SECTION 1. APPLICANT IDENTIFICATION

Information must be typed or printed in the blocks provided to help reduce data entry errors. A physician 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. The email address and point of contract are new data items to facilitate communication that are in the process of OMB approval and will soon be mandatory. Applicant must enter a valid tax identification number (TIN).

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

SECTION 2. BUSINESS ACTIVITY

Indicate only one business activity on this application. Each type of business activity requires a separate application. If you are registered with DEA to manufacture, import, export, or distribute/dispense controlled substances, you do not have to register for the same activities with drug products that contain List 1 chemicals.

• You are required to register as a "manufacturer" if you manufacture a List 1 chemical and then distribute it. You do not have to register if you manufacture a List 1 chemical for internal consumption with no subsequent distribution of it.
   

• Registration as an importer conveys distribution privileges only for those List 1 chemicals imported.

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SECTION 3. SCHEDULES

Applicants is registering for l List 1 chemicals on this application. However, applicants must still comply with state requirements; federal registration does not overrule state restrictions.

• 3B. MANUFACTURER ONLY - Mark the appropriate box to indicate if you are manufacturing List 1 chemicals in bulk or dosage form.
   

• 3C. CHEMICAL CODES -  Applicant must check all List 1 chemicals to be handled and indicate if the chemical is in bulk or dosage form.

Check all chemical codes you handle, and mark if it is bulk or dosage form. For more information, see 21 CFR 1308 or call 1-800-882-9539

SECTION 4. STATE LICENSE(S)

Federal registration by DEA is based upon the applicant 's compliance with applicable state and local laws. Applicants should contact the local state licensing authority prior to completing this application.

If your state requires a license, provide that information and attach a copy to this application. IF YOUR STATE DOES NOT REQUIRE A LICENSE, MARK AN 'X' IN THE BOX TO INDICATE IT IS NOT REQUIRED BY YOUR STATE.

SECTION 5. LIABILITY

Applicants must answer all four questions for the application to be accepted for processing. If you answered "Yes" to any question, provide an explanation in the space provided. If you answer "Yes" to several of the questions, then you must provide a separated explanation describing the location, nature, and result of incident for each "Yes" answer. If additional space is required, you must attach a separate page.

SECTION 6. EXEMPTION FROM APPLICATION FEE

Exemption from payment of application fee is limited to federal, state or local government official or institution. The applicant's superior agency or 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.

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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 SIGNATURE

Applicants MUST sign in this section or the application will be returned. Card holder signature in section 7 does not fulfill this requirement.

Authorization to Convert Your Check:

Checks will be converted via electronic fund transfer (EFT). EFT is the term used to refer to the process where we electronically instruct your financial institution to transfer funds from your account to our account, rather than processing your check. By sending a completed, signed check, you authorize us to copy your check and to use the account information from your check to make an EFT from your account for the same amount on the check. If the EFT cannot be completed for technical reasons, you authorize us to process the copy of your check.

Insufficient Funds:

The EFT 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 EFT cannot be completed because of insufficient funds, we may try to make the transfer up to two times.

Transaction Information:

The EFT 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 scanned copy of the check for record-keeping purposes.

Your Rights:

You should contact your financial institution immediately if you believe that the EFT 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.

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CONTACT INFORMATION