DEA-252 CSOS Principal Coordinator/Alternate Coordinator Certifi

Instructions for completing Form DEA 252
CSOS Principal Coordinator/Alternate Coordinator Certificate Application
Introduction:
Form DEA-252 is for individuals applying to fulfill the role of CSOS Principal Coordinator or
Alternate Coordinator. The Coordinator Applicant may be any individual employed by the DEA
Registrant’s organization and may, but is not required to, sign controlled substance orders. Only
one Principal Coordinator and one Alternate Coordinator may be enrolled for each DEA
Registration number. If the Registrant is requesting to be a Coordinator, he or she should
apply ONLY as a Registrant (Form DEA-251) and indicate him or herself as the Coordinator.
Principal Coordinator
The Principal Coordinator is the primary CSOS contact with regards to CSOS Certificate
applications, renewals, and revocations for the DEA Registration(s) identified on his/her
application. The Registrant may fulfill the role of Coordinator him/herself, or may delegate the
role to any other individual Principal Coordinator must be identified for each DEA Registration
participating in the Controlled Substance Ordering System.
Alternate Coordinator
Optionally, an organization may enroll an Alternate Coordinator. An Alternate Coordinator is
the CSOS contact in the absence of the Principal Coordinator for the DEA Registration(s)
identified on his/her application. Both the Principal Coordinator and Alternate Coordinator are
authorized to revoke or renew any CSOS Certificate issued to an individual subscriber for the
associated DEA Registration Number(s).
Both the Principal Coordinator and Alternate Coordinator fulfill the role of Local Registration
Authority (LRA) for the DEA Registration(s) identified on his/her application. As LRA, the
Coordinator is responsible for verifying the identity and applicability of all other individuals
enrolling as CSOS Power of Attorneys for the associated DEA Registration Number(s).
Completing the application:
The information must be TYPED electronically into the PDF form on-line with the exception
of signatures, affirmations and the notary acknowledgement sections, which must be completed
in blue or black ink. All fields must be completed.
The DEA Registrant must approve the Coordinator Applicant in Section 4. The DEA Registrant
is the individual who signed, or is authorized to sign, the latest application for DEA Registration.
The Coordinator Applicant should review the CSOS Coordinator Certificate Application
Checklist to ensure all required documents are included with his/her application prior to mailing
the application package to the CSOS Registration Authority.

Please contact DEA Diversion E-Commerce Support for enrollment assistance.
Phone: 1-877-DEA-ECOM (1-877-332-3266)
E-mail: CSOSsupport@deaecom.gov

Instructions for completing DEA Form 252
CSOS Principal Coordinator/Alternate Coordinator Certificate Application
If using the United States Postal Service (USPS), mail the completed application and
attachments to:
Drug Enforcement Administration
Sterling Park Technology Center / CSOS
Washington, D.C. 20537
If using Federal Express (FedEx), the United Parcel Service (UPS), or DHL, mail the
completed application and attachments to:
Drug Enforcement Administration
Sterling Park Technology Center / CSOS
8701 Morrissette Drive
Springfield, VA 22152
What the applicant will receive:
The CSOS Coordinator Applicant will receive one CSOS Administrative Certificate for
communication purposes. The Applicant may also request a CSOS Signing Certificate for
electronic ordering of controlled substances. If approved, the Coordinator Applicant will be
issued one CSOS Signing Certificate for each DEA Registration Number requested.
The Coordinator Applicant will receive a pair of activation notices for each certificate issued:
• An E-mail activation notice will be sent for each certificate, which will contain an Access
Code unique to that certificate
• A postal mailed activation notice will be sent for each certificate, which will contain an
Access Code Password unique to that certificate as well as information for logging in to
DEA’s secure certificate retrieval Web site
The codes must be entered on the DEA E-Commerce Web site in order to retrieve the digital
certificate.

Please contact DEA Diversion E-Commerce Support for enrollment assistance.
Phone: 1-877-DEA-ECOM (1-877-332-3266)
E-mail: CSOSsupport@deaecom.gov

Instructions for completing Form DEA 252
CSOS Principal Coordinator/Alternate Coordinator Certificate Application
Section 1 – Applicant Information (all fields required)
Field Name
Applicant Last Name
Applicant First Name
MI
Applicant Social
Security Number
Applicant Bus. Phone

Applicant E-Mail
Address
DEA Registration No.

DEA Registrant Name

Security Code
No. of Addendums

Applicant Business
Address

Information Description
Enter the last name of the applicant.
Enter the first name of the applicant.
Enter the middle initial of the applicant. Enter ‘X’ if the applicant
does not have a middle initial.
Enter the Social Security Number of the applicant. This information
will be kept private and used for internal purposes as stated in the
Privacy Policy.
Enter the business phone number for the applicant. This phone
number will be kept private and will be used only when necessary for
correspondence concerning your CSOS application or CSOS
Certificate(s).
Enter the individual E-mail address for the applicant, which must not
be the same E-mail address as any other applicant. This E-mail
address will be kept private and will be used for correspondence
concerning your CSOS application or CSOS Certificate(s).
Enter the DEA Registration Number for which the applicant is
requesting electronic ordering ability and, if indicated, Principal
Coordinator status. The number entered on the application MUST
appear as it does on the associated DEA Registration Certificate.
Inconsistency between the application and the registration certificate
will result in approval delays or denial.
Enter the name of the DEA Registered location as it appears on the
DEA Registration Certificate (Form 223). Inconsistency between the
application and Registration Certificate will result in approval delays
or denial.
Enter a security code for the applicant. This information will be kept
private and used for authentication purposes. Use letters only. Do not
include any numbers.
Enter the number of CSOS Certificate Application Registrant List
Addendums (DEA Form 254) submitted. Enter ‘0’ if no addendum
forms are attached. DEA Registrant List Addendums allow
applicants to enroll for Certificates for additional DEA Registration
numbers.
Enter the business address of the CSOS Coordinator applicant. This
address may be used for correspondence concerning CSOS Certificate
applications, renewals, and revocations.

Please contact DEA Diversion E-Commerce Support for enrollment assistance.
Phone: 1-877-DEA-ECOM (1-877-332-3266)
E-mail: CSOSsupport@deaecom.gov

Instructions for completing Form DEA 252
CSOS Principal Coordinator/Alternate Coordinator Certificate Application
Section 2 – Applicant Classification (all fields required)
Field Name
1. Are you
applying as
Principal
Coordinator?
Alternate
Coordinator?
2. Do you also
wish to obtain a
CSOS Signing
Certificate for
signing controlled
substance orders
for the identified
DEA
Registrant(s)?

Information Description
Check the appropriate box to indicate whether the applicant is to
serve as Principal Coordinator or Alternate Coordinator. Only one
Principal Coordinator and one Alternate Coordinator may enroll for
each DEA Registration Number. Please note that a Registrant may
be the Principal Coordinator.
Check Yes if requesting a CSOS Signing Certificate, which is
required for signing electronic orders for controlled substances. If
requesting a CSOS Signing Certificate, a CSA Power of Attorney
letter must be submitted with the application.
Check No if requesting only a CSOS Administrative Certificate,
which may not be used for signing electronic orders for controlled
substances.

Section 3 – Applicant/Notary Signature (all fields required)
Field Name
Applicant
Signature, Date
Notary Signature,
Date

Information Description
The applicant must sign and date the application using blue or black
ink IN THE PRESENCE of a certified notary public. The party
signing this application must be the same party listed in Section 1
– Applicant Information (First Name/Last Name/MI).
A CERTIFIED NOTARY PUBLIC must sign using blue or black
ink and seal/stamp each page of the application.

Section 4 – DEA Registrant’s Affirmation of Delegation of Coordinator (all fields required)
Field Name
Organization
Name
Organization
Address
Signature of the
DEA Registrant

Last Name
First Name

Information Description
Enter the organization name under which the DEA Registration(s)
listed is registered, as it is registered with state business licensing.
Enter the organization address under which the DEA
Registration(s) listed is registered, as it is registered with state
business licensing.
The DEA Registrant must sign the application. The DEA
Registrant is the individual who signed, or is authorized to sign, the
most recent application for DEA Registration. By signing this
block, the DEA Registrant certifies that the Coordinator Applicant
identified in Section 1 has been delegated to act as CSOS
Coordinator for the Organization listed above and identified DEA
Registration(s).
Printed last name of the DEA Registrant.
Printed first name of the DEA Registrant.

Please contact DEA Diversion E-Commerce Support for enrollment assistance.
Phone: 1-877-DEA-ECOM (1-877-332-3266)
E-mail: CSOSsupport@deaecom.gov

Instructions for completing Form DEA 252
CSOS Principal Coordinator/Alternate Coordinator Certificate Application
Section 5 – Applicant Signature
Field Name
Applicant
Signature, Date

Information Description
The applicant must sign and date the application using blue or black
ink IN THE PRESENCE of a certified notary public. The party
signing this application must be the same party listed in Section 1
– Applicant Information (First Name/Last Name/MI).

Section 6 – Notary Acknowledgement
Field Name
Notary
Acknowledgement

Information Description
A CERTIFIED NOTARY PUBLIC must complete the
Acknowledgement section using blue or black ink. All fields in this
section, including the notary seal/stamp, must be completed. The
applicant must sign the application in the presences of the
CERTIFIED NOTARY PUBLIC. It is the responsibility of the
applicant to ensure that all information is completed.

Warning: When the applicant signs the application, he/she is stating that he/she has read,
understood, and agreed to abide by the rules and regulations contained in the Controlled
Substance Ordering System Subscriber Agreement and Certificate Policy. He/she is certifying
that the information, statements and representations provided by him/her on the application are
true and accurate to the best of his/her knowledge. He/She understands that presenting false
information is a criminal offense and is punishable by law. Section 843(a)(4)(A) of Title 21,
United States Code, states that any person who knowingly or intentionally furnishes false or
fraudulent information in the application is subject to imprisonment for not more than four years,
a fine of not more than $30,000.00 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 OMB control number for the
collection of this information is 1117-0038. Public reporting burden for this collection of information is
estimated to average 0.72 hour, including time for reviewing instructions, searching existing data sources,
gathering and maintaining the data needed, and completing and reviewing the collection of information.

Please contact DEA Diversion E-Commerce Support for enrollment assistance.
Phone: 1-877-DEA-ECOM (1-877-332-3266)
E-mail: CSOSsupport@deaecom.gov

Approved OMB
NO.1117-0038

Form DEA-252 (01/10)

CSOS Principal Coordinator/Alternate Coordinator Certificate Application
This application is for individuals applying to serve the role of CSOS Principal Coordinator or CSOS Alternate Coordinator. Applicants who hold a
valid Power of Attorney (POA) to obtain and sign Schedules I and/or II controlled substance orders for the DEA Registrant(s) identified will receive
a CSOS Signing Certificate. Read instructions before completing. ALL FIELDS ARE REQUIRED.

Section 1 – Applicant Information
Applicant Last Name

Applicant First Name

MI

Applicant SSN Number

Applicant Bus. Phone

Applicant E-Mail Address

DEA Registration No.

DEA Registrant Name

Security Code (e.g. Mother’s Maiden Name) Letters only. Remember this code to ensure proper identification when you call the Support Desk. No. of Addendums

Applicant Business Address

City

State

Zip

Section 2 – Applicant Classification
1.

Are you applying as Principal Coordinator

2.

Do you also wish to obtain a CSOS Signing Certificate for signing controlled substance orders for the identified DEA Registrant(s)?
Yes

Alternate Coordinator

No

Section 3 – Applicant/Notary Signature
Applicant Signature______________________________________________________________________ Date____________
Notary Signature_________________________________________________________________________Date____________
Note: This application will be denied and returned if not signed and dated by the Coordinator Applicant listed in Section 1 and the Notary listed in Section 6.

Section 4 – DEA Registrant’s Affirmation of Delegation of Coordinator
Organization Name

Organization Address

City

State

Zip

As the individual who signed the most recent application for DEA Registration or the individual authorized to sign the most recent application for DEA
Registration for the DEA Registration numbers submitted with this application I certify the applicant listed in Section 1 has been delegated to act as CSOS
Coordinator for the above organization and identified DEA Registrant(s).

Signature of DEA Registrant ________________________________________________________________Date ___________
Last Name (Print)

First Name (Print)

Section 4 – Applicant Signature

Note: The DEA Registrant is the individual who signed or is authorized to sign the most recent application for DEA Registration. This application will be denied and
returned if Section 4 does not include the signature of the DEA Registrant and a date.

Section 5 – Applicant Signature
By signing this document, I am stating that I have read, understand and agree to abide by the rules and regulations contained in the Controlled Substance Ordering
System Subscriber Agreement and the CSOS DEA Registrant Agreement. I am also certifying that the information, statements, and representations provided by me
on this form are true and accurate to the best of my knowledge. I understand presenting false information is a criminal offense and is punishable by law.
Section 843(a)(4)(A) of Title 21, United States Code, states that any person who knowingly or intentionally furnishes false or fraudulent information in
the application is subject to imprisonment for not more than four years, a fine of not more than $30,000.00 or both.

Applicant Signature _______________________________________________________________________Date ___________

d

Note: This application will be denied and returned if Section 5 does not include the signature of the Coordinator Applicant listed in Section 1 and a date.

Section 6 – Notary Acknowledgement
Instructions to Notary: 1. Modify this form where necessary to assure compliance with the laws of your jurisdiction. Use the back of the
form if necessary. 2. Notary must fully complete the Acknowledgement below 3. Sign and seal/stamp both pages of the form. 4.
Identification #1 must be a government-issued, widely recognized form of photo ID, such as Driver's License or Passport. ID #2 does not
require a photo, but must be different form of ID. Examples: Valid government issued ID, employee ID card, utility or tax bill, major
insurance card, or state pharmacist ID.
State or Commonwealth of ______________________ County of______________________ Country_______________
On______________________ before me,_________________________ personally appeared
________________________________(Applicant) proved to me on the basis of the presentation of two forms of identification listed below
to be the person whose name is subscribed to the within instrument and acknowledged to me that he/she executed the same, and that by
his/her signature on the instrument the person executed the instrument in my presence.
ID #1 (with photograph)
ID #2

Type:____________ Identifying Number:________________ Expiration Date:__________
Type:____________ Identifying Number:________________ Expiration Date:__________

Witness my hand and official seal.
Notary's Signature:_____________________________________________________________________________
Notary's Name (Print or Type):___________________________________________________________________
Notary's Address:_______________________________________________________
Notary's Phone:_______________________ My Commission Expires:_____________

Notary Stamp/Seal

Instructions for completing DEA Form 252
CSOS Coordinator Certificate Application Checklist
Use the following checklist to ensure that your enrollment package is complete. Incomplete applications will
be returned if the requested missing items are not supplied within 90 days.
DEA Registrant (section 4) holds a valid DEA Registration for ordering Schedule I and/or II controlled
substances and employs the Coordinator Applicant.
All DEA Registration numbers listed are valid for ordering Schedule I and/or II substances.
The Coordinator applicant has read, understood, and agreed to the CSOS DEA Registrant Agreement, the
CSOS Subscriber Agreement, and the CSOS Privacy Policy.
The Coordinator applicant must mail all of the following documents to the CSOS Registration Authority
Form DEA-252 – the original, completed, signed, and notarized CSOS Principal Coordinator/Alternate
Coordinator Certificate Application
All fields have been completed – there are no optional fields
The Coordinator Applicant’s E-mail address is a personal account, not shared with any other
individual applicant
The Coordinator has indicated whether he/she requests a CSOS Signing Certificate for electronic
orders of controlled substances. If not requested, only a CSOS Administrative Certificate will be
issued
The Registrant for the DEA Registration numbers listed on form DEA 252 and, if applicable, DEA
254 has signed Section 4, authorizing the Coordinator to enroll
The application has been signed in the presence of a notary, unsigned applications will be denied
and returned
The application has been notarized
Power of Attorney Letter – (required if requesting a CSOS Signing Certificate) a photocopy of the letter
from the Registrant granting Power of Attorney to the Coordinator applicant for each DEA Registration
number identified on form DEA 252 and 254 (if applicable)
Form DEA-223 – a clearly readable photocopy of the DEA Registration certificate for each DEA
Registration number identified on form DEA 252 and DEA 254 (if applicable)
Coordinator Applicant Identifications – photocopies of two clearly readable forms of ID. One form of
ID must be a Government-issued photo ID such as a driver’s license or passport; the second form of ID
does not require a photo and can be anything except for a credit card.
Addendums (Form DEA-254) – only required if the Coordinator applicant is to be Coordinator for more
than one location. Each additional location must be indicated on the CSOS Certificate Registrant List
Addendum (Form DEA-254). If requesting signing authority, one CSOS Signing Certificate will be issued
to the Coordinator for each DEA registration number. Please contact DEA E-Commerce Support if
enrolling for more than 50 DEA Registrations.

Please contact DEA Diversion E-Commerce Support for enrollment assistance.
Phone: 1-877-DEA-ECOM (1-877-332-3266)
E-mail: CSOSsupport@deaecom.gov

Instructions for completing DEA Form 252
CSOS DEA Registrant Certificate Application Checklist
For all carriers, mail the complete application package to:
Drug Enforcement Administration
Sterling Park Technology Center / CSOS
8701 Morrissette Drive
Springfield, VA 22152

Please contact DEA Diversion E-Commerce Support for enrollment assistance.
Phone: 1-877-DEA-ECOM (1-877-332-3266)
E-mail: CSOSsupport@deaecom.gov