Report of Theft or Loss of Controlled Substances and Listed Chemicals - DEA Form 106 and DEA Form 107

Report of Theft or Loss of Listed Chemicals

Under Controlled Substances Act of 1970

INSTRUCTIONS for Form DEA-107, Report of Theft or Loss of Listed Chemicals – Approved OMB Form No. xxxx-xxxx Expires: xx/xx/xxxx

General Instructions

Purpose of Form

The DEA-107 is for reporting any theft or loss of

listed chemicals.

Do not use this form if:

1. The theft or loss you are reporting is not of a

listed chemical, or

2. You want to correct minor inventory shortages.

Additional Information

The online version of Form DEA 107 has 8 sections.

What follows is a description of each section and the

information you will need to successfully fill out this online

form. Please note that for all pages where you are required

to supply information, there is a section labeled “Help.”

For any field on the page for which you require clarification,

place the cursor in the field and click. Help text will appear in

the Help section.

SPECIFIC INSTRUCTIONS

Section 1. Authentication and Report Selection

You will be asked to enter your DEA registration number or your Self Certify Certificate ID

number and your last name or the business name you used to register with the DEA

or to obtain your Self-Certify Certificate ID. The name you supply must match exactly

the name on your registration or Self-Certify Certificate ID. If your business does not have

a DEA registration nor a Self-Certify Certificate ID, you must provide your name, address, and other identifying information. You will be able to choose whether to file a new report or amend a report previously

entered.

Section 2. Theft/Loss Details

You will be asked to provide background information related to this loss or theft

incident, such as the date of the theft or loss, the type (night break-in, armed robbery, etc.),

the estimated value of the listed chemicals, etc. Responses may require additional information,

for example, indicating that a police report has been filed will open new fields requesting the

police department’s name and telephone number.

Section 3. List of Listed Chemicals

You will be asked to provide the trade name of the listed chemical, the base class, the

the name of the listed chemical, the NDC number (if applicable), the package form, and the total quantity lost or stolen.

Section 4 Signature

You will be asked to supply the name and title of the person filing this report.

Section 5 Theft/Loss Summary

Information regarding the details of the theft or loss will be presented to you for

confirmation; changes to the information may be made. You may also change information

in the Signature section.

Section 6 Listed Chemical Summary and Certification

Information on the listed chemicals will be displayed, and may be changed. Additionally, you

will be required to enter the name of the certifying official who attests to the validity of the

information included in the report.

Section 7 Submit Report

Submitting the report will generate an amendment key. Please save the amendment key in order

to be able to modify information using the online DEA-107 report in the future.

Section 8 Print

You may send a copy of the DEA-107 report to your local printer. DEA regulations specify that you

keep a copy of this report for two years.