Controlled Substances Import/Export Declaration--DEA Form 236

INSTRUCTIONS FOR COMPLETING DEA FORM-236

This form is to be used in notifying DEA of all Imports or Exports as required by Title III, PL91-513, Sections 1002 and 1003, as amended (Controlled Substances Import and Export Act, 21 U.S.C. 952 and 953). This form may be prepared and signed by the actual Importer or Exporter or by the Broker or Forwarding Agent used. The following instructions supplement the parts of the DEA-236 which are not completely self-explanatory.

Section 1. “IMPORTER” is the authorized DEA registrant who receives the controlled substance; “EXPORTER” is the authorized DEA registrant who ships the controlled substance.

Section 2. Examples of typical entries in 2a: Trade or Controlled Substance Name 2b: Controlled Substance Name

50 Bottles 50 bottles X 100 tablets/bottle X

100 Tablets/Bottle 15 mg/tablet = 75,000 mg /1,000 =

15 MG/Tablet 75 gm

CSA Drug Code: XXXX

NDC Number: XXXXX-XXXX-XX

Trade or Controlled Substance Name Controlled Substance Name

600 Packages 600 packages X 2 vials/package X

2 Vials/Package 5 ml/vial X 2 mg/ml = 12,000 mg/

5 ML/Vial 1,000 = 12 gm

2 MG/ML

CSA Drug Code: XXXX

NDC Number: XXXXX-XXXX-XX

The DEA registrant should check the DEA Diversion webpage “www.deadiversion.usdoj.gov/quotas/conv_factor/index.html” to find the conversion factor of the controlled substance if it contains a salt (ex. HCL, sulfate, tartrate). If needed, attach additional forms and distribute in the prescribed manner after the required documents are attached to each copy.

Section 3. If this form is prepared as a Controlled Substance Import Declaration, check the foreign box in section 3a, list the city and country name of the port from where the shipment departs the country, and indicate the approximate date it will depart. Check the domestic box in 3b, list the city and state name of the U.S. Customs port where the shipment enters the United States, and indicate the approximate date it will enter.

If this form is prepared as a Controlled Substance Export Declaration, check the domestic box in section 3a, list the city and state name of the U.S. Customs port from where the shipment departs the United States, and indicate the approximate date it will depart. Check the foreign box in 3b, list the city and country name of the foreign port where the shipment enters the country, and indicate the approximate date it will enter.

Section 4. Insert name of vessel or airline and flight number, together with all intermediate carriers. Furnish all information concerning the transportation of the goods known at the time of preparing the DEA Form-236.

Section 5. If this form is prepared as a Controlled Substance Import Declaration, enter the name and address of the foreign consignor. If this form is prepared as a Controlled Substance Export Declaration, enter the name and address of the foreign consignee.

INSTRUCTIONS FOR DISTRIBUTING DEA FORM-236

If this form is prepared as a Controlled Substance Import Declaration, distribute as follows:

Copies 1, 2, and 3 must be forwarded to the foreign shipper. The foreign shipper should submit Copy 1 to the proper foreign government authority, if required, as a prerequisite to obtain an export authorization.

Copy 1 must then accompany the shipment to its final destination and should be retained on file by the importer for at least two years.

Copy 2 must accompany the shipment and should be detached and retained by the appropriate customs official of the foreign country.

Copy 3 must accompany the shipment and should be removed by an official of the U.S. Customs and Border Protection at the port of entry, who shall sign and date the certification of customs, noting any changes by the importer, and should then forward this copy to: Drug Enforcement Administration, Office of Diversion Control, Import/Export Unit (ODGI), 8701 Morrissette Drive, Springfield, VA 22152.

Copy 4 must be mailed by the DEA Registrant at least 15 days prior to the controlled substance(s) arriving into the United States to: Drug Enforcement Administration, Office of Diversion Control, Import/Export Unit (ODGI), 8701 Morrissette Drive, Springfield, VA 22152.

Copy 5 must be retained by the importer as their record of authority for the importation.

If this form is prepared as a Controlled Substance Export Declaration, distribute as follows:

Copies 1, 2, and 3 shall accompany the shipment to certain points.

Copy 1 must accompany the shipment to its final destination.

Copy 2 must accompany the shipment and should be detached and retained by the customs official of the foreign port of importation.

Copy 3 must accompany the shipment and should be detached by an official of the United States Customs and Border Protection at the port of exportation, who shall sign and date the certification of customs, noting any changes by the exporter, and then forward this copy to: Drug Enforcement Administration, Office of Diversion Control, Import/Export Unit (ODGI), 8701 Morrissette Drive, Springfield, VA 22152.

Copy 4 must be mailed by the DEA Registrant at least 15 days prior to the controlled substance(s) departing the United States to the Drug Enforcement Administration, Office of Diversion Control, Import/Export Unit (ODGI), 8701 Morrissette Drive, Springfield, VA 22152.

Copy 5 must be retained by the exporter as their record of authority for the exportation.

PRIVACY ACT INFORMATION

AUTHORITY: Sections 1002 and 1003 of the Controlled Substances Act of 1970 (PL91-513), as amended (21 U.S.C. 952 and 953).

PURPOSE: To obtain information regarding the importation of nonnarcotic substances in Schedules III, IV, and V and the exportation of nonnarcotic substances in Schedules III and IV and all substances in Schedule V.

ROUTINE USES: The Controlled Substances Import/Export Declaration produces special reports as required for statistical and law enforcement purposes. Disclosure of information from this system is made to the following categories of users for the purposes stated.

A. Other Federal law enforcement and regulatory agencies for law enforcement purposes.

B. State and local law enforcement and regulatory agencies for law enforcement and regulatory purposes.

EFFECT: Failure to complete this form will preclude requested importation or exportation of the referenced controlled substances.

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 18 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 Drug Enforcement Administration, FOI and Records Management Section, 8701 Morrissette Drive, Springfield, VA 22152; and to the Office of Management and Budget, Paperwork Reduction Project No. 1117-0009, Washington, D.C. 20503.