Form OMB-NEW DEA Form 332

Reports of dispensing of controlled substances by online pharmacies (DEA Form 332)

DEA Form 332 4-13-2009.xls

DEA Form 332

OMB: 1117-0050

Document [xlsx]
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APPROVED OMB NO. 1117-XXXX



FORM DEA-332 (xx/09)








REPORTS OF DISPENSING OF CONTROLLED SUBSTANCES BY ONLINE PHARMACIES











1.
DEA Registration Number:






2.
Action: _____________ I = Insert new record
U = Update an existing record
D = Delete a previously reported record
N = No activity to report





3.
Reporting Period:






4.
National Drug Code (NDC Number)
Quantity in dosage units

a.



b.



c.



d.



e.



f.



g.



h.



i.



j.



k.



l.



m.



n.




continues as needed








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-XXX. Public reporting burden for this collection of information is estimated to average 15 minutes per response.
File Typeapplication/vnd.ms-excel
AuthorUrsula Bivens
Last Modified Bylbryant
File Modified2009-04-15
File Created2009-02-26

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