Registration Renewal Form

Renewal Application for Registration Under Controlled Substance Act of 1970

This form is for RENEWALS ONLY and is not for new registrations.
You may also use this login to obtain a receipt if you have recently submitted a renewal application using this online application. Remember to use your most current registration information when logging in.
NOTICE: Please do not submit a renewal using this form if you have already mailed in a paper renewal application.

You will need information from your current renewal notice and/or registration certificate in order to login.

This on-line Renewal Form Six (6) sections. Please have the following information available before you begin the application:

Section 1. Personal Information - If changed: Address, phone number.
- If not previously provided: SSN or Tax ID.
Section 2. Activity - If changed: Drug Schedule information.
Section 3. State License(s) - Information pertaining to current State controlled substance licenses/registrations.
Section 4. Background Information - Information pertaining to controlled substances in the applicant's background.
Section 5. Payment - Payment, via this on-line application, must be made with a Visa or MasterCard, American Express, or Discover.
Section 6. Confirmation - Applicants will confirm the entered information, make corrections if needed, and electronically submit the application and a submission confirmation will be presented. Applicants will be able to print copies for their records.

Additional drug or chemical information may be required depending on your business activity.

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.

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DEA Registration Renewal Form Login:

DEA Number (Required - Not Case Sensitive)

Last Name or Business Name (Required - Not Case Sensitive)
As it appears on your registration. Example:
If "Smith, John Q MD" is on your registration, then enter: Smith
If "Smith's, Pharmacy" is on your registration, then enter: Smith's
If "Smith's Pharmacy" (no comma) is on your registration,
then enter: Smith's Pharmacy

First Name (Optional - Not Case Sensitive)
As it appears on your registration. Example:
If "Smith, John MD" is on your registration, then enter: John MD
If "Smith's, Pharmacy" is on your registration, then enter: Pharmacy
If "Smith's Pharmacy" (no comma) is on your registration, then enter nothing

SSN ( Required if given on previous application)

Tax ID (Required if given on previous application)

Current Expiration Date (Required. Listed on registration certificate. In most cases, must be less than 60 days from today's date.)


Month	Day of Month	Year

State (from registered address) (Required).

State:

Zip (Required).

Zip

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