DEA Form 510 - New Application for Registration
This form is for new applicants. Any person who does not currently possess a DEA registration to conduct business with controlled substances as a Chemical Registrant may access the application form and can apply using this form.
- 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
- ADDITIONAL INFORMATION
- CONTACT INFORMATION
Information must be typed or printed in the blocks provided to help reduce data entry errors. A physicial 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.
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.
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?|
|Gamma Butyrolactone (GBL)||2011|
|Hypophosphorous Acid and Salts||6797|
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.
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.
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.
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.
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.
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.
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.
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.
- 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 1117-0015. 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 information.
- The Debt Collection Improvements Act of 1996 (PL 104-134) requires that you furnish your Taxpayer Identification Number and/or Social Security Number on this application. This number is required for debt collection procedures if your fee is not collectible.
- PRIVACY ACT INFORMATION
AUTHORITY: Section 302 and 303 of the Controlled Substances Act of 1970 (PL 91-513) and Debt Collection Improvements Act of 1996 (PL 104-134) for SSN and/or TIN
PURPOSE: To obtain information required to register applicants pursuant to the Controlled Substances Act of 1970
ROUTINE USES: The Controlled Substances Act registration system produces special reports as required for statistical analytical purposes. Disclosures of information from this system are made to the following:
- 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
- Persons registered under the Controlled Substances Act (PL 91-513) for the purpose of verifying registration
INTERNET: Information can be found on our website at www.deadiversion.usdoj.gov
TELEPHONE: Headquarters Call Center: (800) 882-9539
WRITTEN INQUIRIES: Drug Enforcement Administration, Registration Section/ODR, P.O. Box 2639, Springfield, VA 22152-2639