Form DEA Form 225 DEA Form 225 Application for Registration

APPROVED 0MB N01117-0012
FORM DEA-225 (07-19)
Form Expires: 9/30/2021

APPLICATION FOR REGISTRATION

Form-225

Under the Controlled Substances Act

Save time - apply on-line at www.deadiversion.usdoj.gov
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INSTRUCTIONS

DEA OFFICIAL USE:
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Do you have other DEA registration numbers?

To apply by mail complete this application. Keep a copy for your records.
Mail this form to the address provided in Section 7 or use enclosed envelope.
T he "MAIL-TO ADDRESS" can be different than your "PLACE OF BUSINESS" address.
If you have any questions call 800-882-9539 prior to submitting your application.

IMPORTANT: DO NOT SEND THIS APPLICATION AND APPLY ON-LINE.

MAIL-TO ADDRESS

SECTION 1

FEE FOR ONE (1) YEAR - see Section 2
FEE IS NON-REFUNDABLE

Please print mailing address changes to the right of the address in this box.

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APPLICANT IDENTIFICATION

••••·•·•·••• YES

NO

Individual Registration

Name 1

(Last Name of individual -OR- Business or Facility Name)

Name 2

(First Name and Middle Name of individual - OR- Continuation of business name)

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Business Registration

PLACE OF BUSINESS Street Address Line 1

PLACE OF BUSINESS Address Line 2

State

City

Business Phone Number

Point of Contact

Cell Phone Number

Email Address

DEBT COLLECTION
INFORMATION
Mandatory pursuant
to Debt Collection
Improvements Act

SECTION 2
BUSINESS ACTIVITY

Check one
business activity
box only

SECTION 3
A. DRUG

Tax Identification Number (if registration is for business)

Social Security Number (if registration is for individual)

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Provide TIN or SSN.
See additional information
note #3 on page 4.

L. J Analytical Lab...........................fee for one year is $244

::......::: Exporter..............................fee for one year is $1523

:::......:: Researcher w/Sched I..............fee for one year is $244

::......::: lmporter..............................fee for one year is $1523

L. J Researcher w/Sched II - V. .......fee for one year is $244
t.J Canine Handler.........................fee for one year is $244
t.J Distributor.................................fee for one year is $1523

Researcher See page 4
for required
attachments

S CH E DUL ES

Check all that apply

Enter drug codes on
page 2.

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an 'X' to indicate which
drug schedule is handled
in each manufacturing
stage
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Zip Code

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List 1 (L1)-:;��:c;:. ��v&

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Schedule 1

{"] Schedule 2 Non-Narcotic (2N)

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Schedule 2 Narcotic

.:.......:.: Reverse Distributor.............fee for one year is $1523

L.J Manufacturer......................fee for one year is $3047
L.J Manufacturer BULK...........fee for one year is $3047

{"] Schedule 3 Narcotic
{"] Schedule 3 Non-Narcotic (3N)

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Schedule 4
Schedule 5

Check this box if you require official order forms - for purchase of schedule 2 controlled substances.

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STAGE 2
Dosage form manufacture

STAGE 4
Non-human consumption
NEW - Page 1

C. SCHEDULE AND DRUG CODES

Listed below are examples of schedules 1-5. Check all drug codes you handle as required. For more information, see our website at
www.deadiversion.usdoj.gov, 21 CFR 1308, or call 1-800-882-9539.
Ifyou bulk manufacture a substance, check the 'BULK?' column after the applicable class code.