Form OMB-NEW DEA Form 332

		APPROVED OMB NO. 1117-XXXX
		FORM DEA-332 (xx/09)
		REPORTS OF DISPENSING OF CONTROLLED SUBSTANCES BY ONLINE PHARMACIES
1.		DEA Registration Number:
2.		Action:	_____________	I = Insert new record U = Update an existing record D = Delete a previously reported record N = No activity to report
3.		Reporting Period:
4.		National Drug Code (NDC Number)		Quantity in dosage units
	a.
	b.
	c.
	d.
	e.
	f.
	g.
	h.
	i.
	j.
	k.
	l.
	m.
	n.
		continues as needed
		In accordance with the Paperwork Reduction Act of 1995, no person is required to respond to a collection of information unless it displays a valid OMB control number. The OMB number for this collection is 1117-XXX. Public reporting burden for this collection of information is estimated to average 15 minutes per response.