Import/Export Declaration for List I and List II Chemicals (Year)

INSTRUCTIONS FOR COMPLETING IMPORT/EXPORT DECLARATION, DEA FORM 486
(Also available on-line at www.deadiversion.usdoj.gov)
This form is to be used in notifying DEA of all imports, exports, and international transactions (except imports of ephedrine,
pseudoephedrine, and phenylpropanolamine for which DEA Form 486a is required) as required by the Controlled
Substances Import and Export Act (21 U.S.C. 971). The following instructions supplement the parts of the DEA Form 486
that are not completely self-explanatory. Detailed requirements are found in Title 21 CFR Parts 1300, 1310 and 1313.
Initial Completion of Form
Fill in 1a – 5, except for 3d. For imports, fill in information for transferees in 7a – 7c, 8a -8c, and 9a - 9c. If the importer is
the end user, fill in 7a with “end user”; leave 7b blank; in 7c write “same as 3c”. Sign at the bottom of page 1 and date. After
your request is successfully processed by DEA, a transaction number will be issued for this transaction. The transaction
number MUST be used for any action related to this transaction.
Completing Form Upon Completion of the Transaction
Upon completion of the import, export, or international transaction, fill in 3d, Date of Actual Import/Export and Actual Quantity
for the entire transaction. For exporters and international transactions, not later than 30 days after the actual date of export
or international transaction, complete 6, sign and date. For importers fill in 7d, 8d, and 9d, Name and Quantity of Chemical
Actually Imported and Date for each Transferee, as appropriate. Not later than 30 days after the actual date of import,
complete, sign, and date 7e, 8e, 9e, Return Declaration, as appropriate. If the entire quantity of chemicals imported is not
distributed within 30 days, not later than 30 days after the next distribution is complete, sign, and date whatever portions of
7e, 8e, or 9e were distributed. The importer must file supplemental Return Declarations not later than 30 days from the date
of any further distribution until the disposition of all chemicals imported under the import notification have been distributed.
Make a copy and mail or fax to DEA.
“List I chemical” means the following substances: (1) N-acetylanthranilic acid and its salts (2) Anthranilic acid and its salts
(3) Benzaldehyde (4) Benzyl cyanide (5) Ephedrine and its salts, optical isomers, and salts of optical isomers (6)
Ergonovine and its salts (7) Ergotamine and its salts (8) Ethylamine and its salts (9) gamma-Butyrolactone (GBL) (10)
Hydriodic acid (11) Hypophosphorous acid and its salts, (12) Iodine (13) Isosafrole (14) Methylamine and its salts
(15) 3,4-Methylenedioxphenyl-2-propanone (16) N-Methylephedrine and its salts, optical isomers, and salts of optical
isomers (17) N-Methylpseudoephedrine and its salts, optical isomers, and salts of optical isomers (18) N-Phenethyl-4piperidone (NPP) (19) Nitroethane (20) Norpseudoephedrine and its salts, optical isomers, and salts of optical isomers (21)
Phenylacetic acid and its salts and esters (22) Phenylpropanolamine and its salts, optical isomers, and salts of optical
isomers (23) Phosphorus (red) (24) Phosphorus (white or yellow) (25) Piperidine and its salts (26) Piperonal (heliotropine)
(27) Propionic anhydride (28) Pseudoephedrine and its salts, optical isomers, and salts of optical isomers* (29) Safrole
(See 21 CFR Part 1310 for updated list.)
“List II chemical” means the following substances: (1) Acetic anhydride (2) Acetone (3) Benzyl chloride
(4) Ethyl ether (5) Hydrochloric acid (6) Hydrogen chloride gas (7) Methyl ethyl ketone (2-Butanone) (8) Methyl isobutyl
ketone (9) Potassium permanganate (10) Sulfuric acid (11) Toulene (See 21 CFR Part 1310 for updated list.)
“Transferee” means a person/entity to whom an importer or exporter transfers (including sales) a listed chemical.
Part 1. The terms “Importer” and “Exporter” include the regulated person who, as the principal party in interest in the import
or export transaction, has the power and responsibility for determining and controlling the bringing in or taking out of any
chemical listed in 21 CFR 1310.02 that meets or exceeds the threshold quantity found in 21 CFR 1310.04. If the 15-day
advance notification requirement has been waived, the regulated person must check block 1(c).
The term “Broker” means a legal entity that assists in arranging an international transaction in a listed chemical by (1)
negotiating contracts; (2) serving as an agent or intermediary; or (3) fulfilling a formal obligation to complete the transaction
by bringing together a buyer and seller, a buyer and transporter, or a seller and transporter, or by receiving any form of
compensation for so doing. Waiver of the 15-day advance notification does not apply to international transactions.
Part 2. The foreign consignor is the supplier of the chemical. The foreign transferee is the foreign person importing the
chemical.

Part 3. EXAMPLES
Conversion Factors
Ephedrine HCl
Ephedrine Sulfate
Phenylpropanolamine HCL

Percent
81.92%
77.12%
80.57%

C.F.
0.8192
0.7712
0.8057

Pseudoephedrine HCl
Pseudoephedrine Sulfate

Percent
81.92%
77.12%

C.F.
0.8192
0.7712

3a. Name and Description of chemical appearing
on label or container. For drug products, show
dosage strength and dosage size.

3b. Name of chemicals as
designated by Title 21 CFR
1310.02

3c. Number of containers, size, net
weight of each chemical (kg)

For Bulk
Piperonal

Piperonal

3 X 150 kg drums
450 kg net wt

For Drug Products
(report in base weight)
“Brand Name” tablets (ephedrine HCL)

Ephedrine

25 mg per tablet
100 tablets per bottle
48 bottles per case
100 cases per pallet
2 pallets = 24 kg
24 kg X 0.8192 = 19.66 kgs

INSTRUCTIONS FOR DISTRIBUTING DEA FORM 486
For Import Declaration distribute as follows: Copy 1 must be retained on file by the regulated person as the official record
of import. Import declaration forms must be retained for two years. Copy 2 is a DEA copy. This form must be received at
8701 Morrissette Drive, Springfield, VA 22152 or sent via electronic facsimile to telephone no. 202-307-4702 at least 15 days
prior to importation. Regulated persons who have satisfied the requirements for waiver of the 15-day advance notice
described in 21 CFR 1313.15 are required to provide notification on or before the day of importation. Copy 3 must be
presented to U.S. Customs and Border Protection pursuant to 21 CFR 1313.14(c). Copy 4 is also a DEA copy and must be
mailed to DEA not later than 30 days after the actual date of importation with the actual date of import, the actual quantity
imported, and the Return Declaration filled in, signed, and dated (if faxed, copy 2 can be updated and retransmitted). If the
entire import is not distributed, not later than 30 days after the next distribution, complete, sign, and date a supplemental
Return Declaration. The importer must file supplemental Return Declarations not later than 30 days from the date of any
further distribution until the disposition of all chemicals imported under the import notification have been distributed. Make a
copy and mail or fax to DEA.
For Export Declaration distribute as follows: Copy 1 must be retained on file by the regulated person as the official record
of export. Export declaration forms must be retained for two years. Copy 2 is a DEA copy. This form must be received at
8701 Morrissette Drive, Springfield, VA 22152 or via electronic facsimile to telephone no. 202-307-4702 at least 15 days
prior to exportation. Regulated persons who have satisfied the requirements for waiver of the 15-day advance notice
described in 21 CFR 1313.24 are required to provide notification on or before the day of exportation. Copy 3 must be
presented to U.S. Customs and Border Protection pursuant to 21 CFR 1313.23(c). Copy 4 is also a DEA copy and must be
mailed to DEA not later than 30 days after the actual date of exportation with the actual date of export, the actual quantity
exported, and the Return Declaration filled in with the name of the foreign importer, signed, and dated (if faxed, Copy 2 can
be updated and retransmitted).
For International Transaction Declaration distribute as follows: Copy 1 must be retained on file by the broker or trader as
the official record of the international transaction. Declaration forms must be retained for two years. Copy 2 is the DEA
copy. Notification must be received at 8701 Morrissette Drive, Springfield, VA 22152 or via electronic facsimile to telephone
no. 202-307-4702 at least 15 days prior to the international transaction. Waiver of the 15-day advance notification does not
apply to international transactions. Copy 3 is also a DEA copy and must be sent to DEA 30 days after the actual date of the
international transaction with the actual date of international transaction, the actual quantity imported/exported, and the
Return Declaration filled in, signed, and dated. Fax or mail to DEA.

Privacy Act Information
Authority: Section 1018 of the Controlled Substances Import and Export Act
Purpose: To obtain information regarding the import/export of certain chemicals to prevent the illicit manufacture of controlled
substances.
Routine Uses: The Import/Export Declaration produces information required for law enforcement purposes. Disclosure of
information is 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.

C.

Person registered under the Controlled Substances Act (P.L. 91-513) for the purpose of verifying the
registration of customers

Effect: Failure to complete this form will preclude the import/export of the chemicals mentioned.
Under the Paperwork Reduction Act, a person is not required to respond to a collection of information unless it displays a current
valid OMB control number. Public report burden for this collection of information is estimated to average 12 minutes per response
for exports and international transactions, 15 minutes per response for imports, and 5 minutes per response for Return Declarations,
including the time for reviewing instructions, searching existing data source, 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 FOI and Records Management Section, Drug
Enforcement Administration, Washington, D.C. 20537; and the Office of Management and budget, Paperwork Reduction Project No.
1117-486a, Washington, D.C. 20503.