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

DEA FORM 357

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 357

This application must be completed in triplicate. Original is sent to DEA. See instruction 6c for copies two and three.

Importation of any controlled substance listed in schedule I or II or any narcotic drug listed in schedule III, IV, or V should be made pursuant to 21 CFR, Section 1312.13, parts (a) and (b) or any schedule III through V nonnarcotic controlled substance as specifically designated by 21 CFR, Section 1312.30.

Permits when issued will be mailed to the importer at the address shown on the application unless contrary instructions are received. Application should be made in the name of the official whose registration is on file with the Drug Enforcement Administration.

6. Identification of drugs to be imported and the controlled substance content should be entered on the application in the following manner:

6a. NAME AND QUANTITY OF DRUG OR
PREPARATION TO BE IMPORTED AND NUMBER OF
CONTAINERS
6b. CONTROLLED SUBSTANCE CONTENT OF
DRUG OR PREPARATION TO BE IMPORTED
(expressed as acid, base or alkaloid, not salt)
1 Vial x 0.1 mg Cocaine d3 Cocaine 0.1 mg
1 vial x 5.0 mg Phen-d5-cyclidine HC1 Phencyclidine 4.35 mg
250 Cases containing a total of 15,100 kg Crude
Indian Opium (10% AMA)
Opium 1,500 kg AMA
3,600 kg Poppy Straw Concentrate 75-80% AMA Poppy Straw Concentrate 2,700-2,800 kg AMA

6c. The following information must be entered in block 6c of copies 2 and 3 at the time of import:

(1) DEA Import Permit No. and (2) actual quantity and date received. Copy 2 is sent to DEA. Copy 3 is retained by importer.

7. Importers of crude opium, poppy straw, concentrate of poppy straw, and coca leaves complete this section.

8. If applicable, the scientific uses to which the drug is to be put after import should be stated briefly, such as:

"For chemical and clinical study of its properties and suitability for medical distribution."

"For use in laboratory and pilot plant studies of methods of extraction (or production) of its component alkaloids." Etc.

PRIVACY ACT INFORMATION

Authority: Section 1002 of the Controlled Substances Act of 1970 (PL 91-513).
Purpose:
Control importation 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. 1117-0013, 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