Registration Renewal Form - Login Screen

Renewal Application for Registration Under Controlled Substance Act of 1970

ONLY USE THIS FORM TO:

RENEW YOUR DEA REGISTRATION (Do not use for NEW Registrations or if you have already mailed in a paper form).

OBTAIN A RECEIPT for recent renewal submitted via this on-line form.

ON-LINE RENEWAL CONSISTS OF SIX (6) SECTIONS. You will need information from your current renewal notice and/or registration certificate in order to login. Please have the following information available before you begin the application:

Section 1. Personal/Business Information
Review current information. If changed: Address, phone number. If not previously provided: SSN or Tax ID.

Section 2. Activity
If changed: Drug Schedule information. In addition - Certain registrants for forms 225 and 510 will need to provide specific drug codes and/or chemical codes related to their operations.

Section 3. State License(s)
Information pertaining to current State medical and/or 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. Application fees are not refundable.

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.

WARNING: 21 USC 843(d), states that any person who knowingly or intentionally furnishes false or fraudulent information in the application is subject to a term of imprisonment of not more than 4 years, and a fine under Title 18 of not more than $250,000, 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)

Expire Date Year Expire Date Month Expire Date Day

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

State (from registered address) (Required).

Zip (from registered address) (Required).

Please do not use your browser's BACK and FORWARD buttons while navigating this form.

ADDITIONAL INFORMATION

Form 224A Approved OMB Form No. 1117-0014 Expires: 11/30/2011 (12 minutes)
Form 225A Approved OMB Form No. 1117-0012 Expires: 03/31/2012(15 minutes)
Form 510A Approved OMB Form No. 1117-0031 Expires: 03/31/2013 (15 minutes)
Form 363A Approved OMB Form No. 1117-0015 Expires: 03/31/2012 (15 minutes)

No registration will be issued unless a completed application form has been received (21 CFR 1301.13).
In accordance with the Paperwork Reduction Act of 1995, no person is required to respond to a collection of information unless it displays a valid OMB control number. The OMB number for this collection is (See Above). Public reporting burden for this collection of information is estimated to average (See Above) per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the information.
The Debt Collection Improvements Act of 1996 (31 U.S.C. §7701) requires that you furnish your Taxpayer Identification Number (TIN) or Social Security Number (SSN) on this application. This number is required for debt collection procedures if your fee is not collectible.
PRIVACY ACT NOTICE:
Providing information other than your SSN or TIN is voluntary; however, failure to furnish it will preclude processing of the application. The authorities for collection of this information are §§302 and 303 of the Controlled Substances Act (CSA) (21 U.S.C. §§822 and 823). The principle purpose for which the information will be used is to register applicants pursuant to the CSA. The information may be disclosed to other Federal law enforcement and regulatory agencies for law enforcement and regulatory purposes, State and local law enforcement and regulatory agencies for law enforcement and regulatory purposes, and person registered under the CSA for the purpose of verifying registration. For further guidance regarding how your information may be used or disclosed, and a complete list of the routine uses of this collection, please see the DEA System of Records Notice "Controlled Substances Act Registration Records" (DEA-005), 52 FR 47208, December 11, 1987, as modified.

DEA OFFICE OF DIVERSION CONTROL PRIVACY POLICY