Office of Diversion Control, US Department of Justice, Drug Enforcement Administration

DEA FORM 161

The application or declaration listed below is available in PDF format in two ways – 1. As an interactive form which can be completed online and printed on your printer, or 2. As a blank form to be printed on your printer. This second version is not recommended; fewer errors occur if the form is entered online and then printed.


INFORMATION AND INSTRUCTIONS, DEA FORM 161

This application must be completed in triplicate. Original is sent to DEA. See instruction 7 for copies two and three.

  1. The name and address of the consignee as shown on this application and on the permit to export must correspond with that shown on the foreign import certificate.
  2. To avoid delays in clearance at the port of export be sure to enter the correct port on this application. A copy of your export permit is sent directly to the District Director of Customs at the port indicated on the application for comparison with the permit presented for clearance of the shipment. The shipment will not clear at any other port without an amendment of the permit indicating a change to that effect.
  3. The original or an authentic signed and/or notarized copy of the foreign import certificate must accompany this application. If this certificate is needed to accomplish entry of the drug into the country of destination, your request for its return to you should accompany the application.
  4. Application should be made in the name of the registered legal entity, as shown on the DEA registration certificate, and signed by a responsible authorized official if a corporation, by a partner, or by the person registered as an individual. Only persons registered as exporters or as analytical laboratories may be issued export permits. The registrations of manufacturers, distributors, practitioners, researchers, etc., do not entitle them to export controlled substances.
  5. Permits will be mailed to the exporter at the address shown at the bottom of the application unless contrary instructions are attached to and made a part of this application.
  6. Identification of drugs to be exported and the controlled substance content should be entered on the application in the following manner:
7a. NAME AND QUANTITY OF DRUG OR
PREPARATION TO BE EXPORTED
7b. CONTROLLED SUBSTANCE CONTENT OF
DRUG OR PREPARATION TO BE EXPORTED
(expressed as acid, base or alkaloid, not salt)
3 bottles x 100 Secobarbital Sodium capusules
(100 mg./capsule)
secobarbital 27.47 gm
2 boxes x 100 Meperidine HCl ampules (5%, 2
ml. ampules)
meperidine 17.43 gm
1 box x 100 Meperidine HCl vials (10%, 20 ml.,
vials)
meperidine 174.30 gm
2 x 1 Pt. Meperidine HCl Syrup (50 mg./5 ml.,
pints)
meperidine 8.24 gm
1 box x 100 gm. Detroamphetamine Sulfate
powder
dextroamphetamine 73.38 gm
1 bottle x 500 Hydromorphone HCl tablets (4
mg./tablets)
hydromorphone 1.77 gm
  1. The following information must be entered in block 7c at the time of export: (1) DEA Export Permit Number and (2) actual quantity and date shipped. Copy 2 is sent to DEA, and Copy 3 is retained by the registrant.

PRIVACY ACT INFORMATION

Authority: Section 1003 of the Controlled Substances Act of 1970 (PL 91-513).

Purpose: Control exportation of certain Controlled Substances into the United States.

Routine Uses: The Controlled Substances Act Registration Records produces special reports required for statistical analytical purposes. Disclosures of information from this system are made to the following categories of users for the purposes stated:

  1. Other Federal law enforcement and regulatory agencies for law enforcement and regulatory purposes.

  2. State and local law enforcement and regulatory agencies for law enforcement and regulatory purposes.

  3. Persons registered under the Controlled Substances Act (Public Law 91-513) for purposes of verifying the registration of customers and practitioners.

Effect: No permit will be issued.

Under the Paperwork Reduction Act, a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. 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 collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the FOI and Records Management Section, Drug Enforcement Administration, Washington, D.C. 20537; and to the Office of Management and Budget, Paperwork Reduction Project No. 1117-0004, Washington, D.C. 20503.

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U.S. DEPARTMENT OF JUSTICE  •  DRUG ENFORCEMENT ADMINISTRATION
Office of Diversion Control  •  8701 Morrissette Drive  •  Springfield, VA 22152  •  1-800-882-9539