This form is used by regulated sellers who sell scheduled listed chemical products to self-certify to the Drug Enforcement Administration. The application fee amount is $21. Certification fees are not refundable. Each location must self-certify annually.
Note that each separate physical location at which scheduled listed chemical products are sold at retail must be certified.
This on-line application will step you through the self certificate process. You must have the below information available before you begin.
Step 1. Background Information - Business name, address, tax identification number, your name, phone number, and email address.
Step 2. Confirmation - The person certifying must confirm the information, make corrections if needed, and then electronically submit the information.
Step 3. Printing Certification - The applicant will be able to print a copy of their certificate upon completion of this process.
WARNING : Section 1001 of Title 18, United States Code, states that whoever, in any matter within the jurisdiction of the executive, legislative, or judicial branch of the Government of the United States, knowingly and willfully falsifies, conceals, or covers up by any trick, scheme, or device a material fact, or makes any materially false, fictitious, or fraudulent statement or representation, or makes or uses any false writing or document knowing the same to contain any materially false, fictitious, or fraudulent statement or entry, shall be fined not more than $250,000 if an individual or $500,000 if an organization, imprisoned not more than five years, or both.
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 valid OMB control number for this collection is 1117-0046. Public reporting burden for this collection of information is estimated to average 5 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.
AUTHORITY: Section 711 of the Combat Methamphetamine Epidemic Act of 2005 (PL 109-177) PURPOSE: To obtain information required to self-certify sellers of scheduled listed chemical products pursuant to the Combat Methamphetamine Epidemic Act of 2005. ROUTINE USES: The combat Methamphetamine Epidemic Act self-certification records are used to produce special reports as required for statistical analytical purposes. Disclosures of information from this system are made to the following categories of users for the purposes stated:
A. Other federal law enforcement and regulatory agencies for law enforcement and regulatory purposes. B. State and local law enforcement and regulatory agencies for law enforcement and regulatory purposes. EFFECT: Failure to complete this form will preclude processing of the self-certification. Please do not use your browser's BACK and FORWARD buttons while navigating this form.
Combat Methamphetamine Epidemic Act of 2005
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