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DEA Form 510 - Domestic Chemicals
New Application for Registration - Instructions
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
List 1 |
Chemical Name |
Code |
Bulk? |
Dosage? |
|
3,4-Methylenedioxyphenyl-2-Propanone |
9809 |
|
|
|
Anthranilic Acid |
8530 |
|
|
|
Benzaldehyde |
8256 |
|
|
|
Benzyl Cyanide |
8735 |
|
|
|
Ephedrine |
8113 |
|
|
|
Ergonovine |
8675 |
|
|
|
Ergotamine |
8676 |
|
|
|
Ethylamine |
8678 |
|
|
|
Gamma Butyrolactone (GBL) |
2011 |
|
|
|
Hydriodic Acid |
6695 |
|
|
|
Hypophosphorous Acid and Salts |
6797 |
|
|
|
Isosafrole |
8704 |
|
|
|
Methylamine |
8520 |
|
|
|
N-Acetylanthranilic Acid |
8522 |
|
|
|
N-Methylephedrine |
8115 |
|
|
|
N-Methylpseudoephedrine |
8119 |
|
|
|
Nitroethane |
6724 |
|
|
|
Norpseudoephedrine |
8317 |
|
|
|
Phenylacetic Acid |
8791 |
|
|
|
Phenylpropanolamine |
1225 |
|
|
|
Piperidine |
2704 |
|
|
|
Piperonal |
8750 |
|
|
|
Propionic Anhydride |
8328 |
|
|
|
Pseudoephedrine |
8112 |
|
|
|
Red Phosphorus |
6795 |
|
|
|
Safrole |
8323 |
|
|
|
White Phosphorus |
6796 |
|
|
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.
NOTICE TO REGISTRANTS PAYING BY CHECK
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
1. INTERNET: |
Information can be found on our web site at
www.deadiversion.usdoj.gov |
2. TELEPHONE: |
Headquarters Processing Center:
800-882-9539 |
3. WRITTEN INQUIRIES |
Drug
Enforcement Administration
Registration Section/ODR
P.O. Box 2639
Springfield, VA 22152-2639 |
4. DEA
OFFICES |
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