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pdfDrug Enforcement Administration
Reports for Regulated Machines
Web Tracking No.:
Federal Regulations require a regulated person to submit a detailed report of any Import or Export of tableting or encapsulating machines. A
tableting machine or encapsulating machine may not be imported or exported until a DEA transaction identification has been filed by the
Administration. Federal regulations require a regulated person to submit a detailed report of all domestic regulated transactions in a tableting
machine or encapsulating machine.
1. Type of Request:
OMB Approval No. 1117-0024
2. Type of Submission:
3. Purpose Need:
[ ] ORIGINAL
[ ] Medical
[ ] AMENDED
[ ] Commercial
Expiration Date: 06/30/2018
[ ] WITHDRAWAL
[ ] Scientific
[ ] Other (please describe):
4. Proposed Date of Export:
DEA Transaction ID:
Anticipated Foreign Port of Entry:
Country of Entry:
5. Regulated Person: (Business Name, Business Address):
6. Intermediate Consignee – if any: (Business Name, Business Address):
Registration Number (required if registered):
Country:
POC Name:
POC Name:
Email address:
Email address:
Business Phone:
Business Phone:
7. Consignee: (Business Name, Business Address):
Country:
POC Name:
Email address:
Business Phone:
E-SIGNATURE OF AUTHORIZED INDIVIDUAL:
PRIVACY ACT INFORMATION
AUTHORITY: Title 21 U.S.C. 802 and 830
PURPOSE: Report of Regulated Machines.
ROUTINE USES: The Controlled Substances Act authorizes the
production of special reports required for statistical and analytical
purposes. Disclosures of information from this system are 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.
EFFECT: Failure to report may result in penalties under Section 402
and 403 of the Controlled Substances Act.
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.
DEA FORM - 452 (Previous version obsolete.)
DATE:
Public reporting burden for this collection of information is estimated
to average 15 minutes per response for imports, exports, and
domestic transactions, and 5 minutes per response for Return
Declarations, 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, Attn: Federal
Register Representative/ODW, 8701 Morrissette Drive, Springfield,
VA 22152; and to the Office of Management and Budget, Paperwork
Reduction Project No. 1117-0024, Washington, D.C. 20503.
Freedom of Information: Please prominently identify any
confidential business information per 28 CFR 16.8(c) and Exemption
4 of the Freedom of Information Act (FOIA). In the event DEA
receives a FOIA request to obtain such information, DEA will give
written notice to the registrant to obtain such information. DEA will
give written notice to the registrant to allow an opportunity to object
prior to the release of information.
8. Description of Each Machine
Machine Type: [ ] Encapsulating
[ ] Tableting
Machine Type: [ ] Encapsulating
DEA Transaction ID:
[ ] Tableting
Machine Type: [ ] Encapsulating
Serial #:
Serial #:
Serial #:
Make:
Make:
Make:
Model:
Model:
Model:
[ ] Electric
[ ] Manual
[ ] Electric
Description:
[ ] Manual
[ ] Electric
Description:
Machine Type: [ ] Encapsulating
[ ] Tableting
Machine Type: [ ] Encapsulating
[ ] Tableting
Machine Type: [ ] Encapsulating
Serial #:
Serial #:
Make:
Make:
Make:
Model:
Model:
Model:
[ ] Manual
[ ] Electric
Description:
[ ] Manual
[ ] Electric
Description:
Machine Type: [ ] Encapsulating
[ ] Tableting
Machine Type: [ ] Encapsulating
[ ] Tableting
Serial #:
Make:
Make:
Make:
Model:
Model:
Model:
[ ] Manual
[ ] Electric
[ ] Manual
[ ] Electric
Description:
Machine Type: [ ] Encapsulating
[ ] Tableting
Machine Type: [ ] Encapsulating
[ ] Tableting
Serial #:
Make:
Make:
Make:
Model:
[ ] Manual
[ ] Electric
Description:
[ ] Tableting
[ ] Electric
Machine Type: [ ] Encapsulating
[ ] Tableting
Machine Type: [ ] Encapsulating
Serial #:
Serial #:
Make:
Make:
Make:
Model:
Model:
Model:
[ ] Manual
[ ] Electric
Description:
[ ] Manual
[ ] Electric
Description:
Machine Type: [ ] Encapsulating
[ ] Tableting
Machine Type: [ ] Encapsulating
[ ] Tableting
Serial #:
Make:
Make:
Make:
Model:
Model:
Model:
Description:
DEA FORM - 452 (Previous version obsolete.)
[ ] Electric
Description:
[ ] Manual
Machine Type: [ ] Encapsulating
Serial #:
[ ] Manual
[ ] Tableting
Description:
Serial #:
[ ] Electric
[ ] Manual
Description:
Serial #:
[ ] Electric
[ ] Tableting
Model:
[ ] Manual
Description:
Machine Type: [ ] Encapsulating
[ ] Manual
Machine Type: [ ] Encapsulating
Serial #:
[ ] Electric
[ ] Tableting
Description:
Serial #:
Model:
[ ] Manual
Machine Type: [ ] Encapsulating
Serial #:
[ ] Electric
[ ] Tableting
Description:
Serial #:
Description:
[ ] Manual
Description:
Serial #:
[ ] Electric
[ ] Tableting
[ ] Manual
[ ] Electric
Description:
[ ] Manual
[ ] Tableting
| File Type | application/pdf |
| Author | DEA |
| File Modified | 2017-07-21 |
| File Created | 2017-07-20 |