Application for Registration Under Controlled Substances Act of 1970
- 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.