486A Import Declaration for Ephedrine, Pseudoephedrine, and P

U.S. Department of Justice / Drug Enforcement Administration

Import Declaration for Ephedrine, Pseudoephedrine, and Phenylpropanolamine
(read instructions and Privacy Act before completing)
DEA Transaction
No.*: Date of Issue:
Date of Expiration:

OMB Approval No. 1117-0023
Expiration Date: 11/30/2019

NOTICE! A 15-day advance notice is required for all U.S. imports of Ephedrine, Pseudoephedrine,
and Phenylpropanolamine.
Reference No.:

*This declaration is not deemed filed, and therefore is not valid, until the Drug Enforcement Administration (DEA) has issued a DEA Transaction number
1b. Customs Broker (company name and address)

1a. Importer (company name and address)

DEA Registration No.:
2. List Chemicals to be Imported
2a. Product name on label or container; Packaging details; 2b. Name of listed chemical; Net weight (expressed as base)
DEA Chemical Code (see 21 CFR § 1310.02)
calculations in kilograms or parts thereof

3a. Port of Export:
and anticipated Date of Departure:

2c. Return Information
(see instructions)

3b. Port of Import:
and anticipated Date of Arrival:

4. Mode of Transport and name(s) of carrier or vessel:
5a. Foreign Exporter (company name and address)

5b. Foreign Manufacturer (company name and address)

5c. Foreign Distributor (company name and address)

Signature of Authorized Individual of Importer

Name of Firm and contact information of person submitting DEA Form-486A

Print Name:

Date:

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DEA Form-486A

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