Get the free DEA Form 106 and Loss of Controlled Substances
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LIST OF CONTROLLED SUBSTANCES LOSTFORM DEA106 (Sep. 2007) Pg. 2 Trade Name of Substance or Preparation ExamplesDesoxynNDC NumberName of Controlled Substance in PreparationDosage StrengthDosage FormTotal
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How to fill out dea form 106 and
How to fill out dea form 106 and
01
Obtain DEA form 106 from the Drug Enforcement Administration website or from your employer.
02
Fill in your personal information in section 1, including your name, address, and DEA registration number.
03
Provide the details of the drug loss or theft in section 2, including the date of discovery, circumstances of the loss, and estimated quantity of drugs involved.
04
Sign and date the form in section 3, certifying the information you provided is true and accurate.
05
Submit the completed DEA form 106 to the Drug Enforcement Administration within 10 days of the discovery of the loss or theft.
Who needs dea form 106 and?
01
Anyone who is registered with the DEA and experiences a loss or theft of controlled substances needs to fill out DEA form 106.
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What is DEA Form 106?
DEA Form 106 is a report used to document the theft or significant loss of controlled substances.
Who is required to file DEA Form 106?
Any DEA-registered entity or individual that experiences a theft or significant loss of controlled substances is required to file DEA Form 106.
How to fill out DEA Form 106?
To fill out DEA Form 106, provide information such as the registrant's details, a description of the controlled substances lost or stolen, and circumstances surrounding the incident.
What is the purpose of DEA Form 106?
The purpose of DEA Form 106 is to inform the DEA of any theft or significant loss of controlled substances, ensuring proper investigation and tracking.
What information must be reported on DEA Form 106?
Information reported on DEA Form 106 includes the entity's registration number, name, address, date and time of the incident, a description of the controlled substances, and details of the loss or theft.
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