Online Example

Attachment 6. Traceable Opioid Material* Kits Questions (Online Example 1)

FORENSIC SCIENCE PRODUCTS
About Cayman Forensic

Product Search &
Drug Idenficaon

Resources & Literature

Forensic Services

Tools
PRODUCT & ATTRIBUTE
SEARCH

GC­MS DRUG
IDENTIFICATION TOOL

SYNTHETIC CANNABINOID
FLIPBOOK

FENTANYL ANALOG SCREENING
(FAS) KIT

Fentanyl Analog Screening (FAS) Kit
The Centers for Disease Control and Prevenon (CDC) has
developed Traceable Opioid Material* Kits to support laboratory
detecon of current and emerging opioids in the U.S. The CDC has
contracted Cayman Chemical to manufacture and distribute the FAS
Kit, which is part of the Traceable Opioid Material* Kits product line.
The FAS Kit and its expansion packs (Emergent Panels Version 1, 2,
and 3) contain analog reference materials that enable labs to screen
for 212 synthec opioid compounds, including more than 190
fentanyl analogs. To view the enre list of compounds included in
the kit, please download the compound list (PDF).

Is My Lab Eligible for a Free FAS Kit?
Labs that perform drug tesng or analysis may apply for a free FAS Kit if they meet the following requirements:
·Must be located in the U.S. (or a U.S. Territory) with a verifiable business address
·Hold a valid DEA controlled substance registraon for Schedule I controlled substances
To start the applicaon process for a new DEA controlled substance registraon, go to
h5ps://apps.deadiversion.usdoj.gov/webforms/jsp/regapps/common/newAppLogin.jsp.
For addional guidance, contact DEA’s Registraon Call Center at 1­800­882­9539 or a local DEA field office. A descripon of the
registraon process and a link to DEA’s field office search tool can be found at h;ps://www.deadiversion.usdoj.gov/drugreg/process.htm.

FAS Kit Applicaon
To be considered for a free FAS Kit, please ensure your lab meets the eligibility requirements stated above and completely fill out the
applicaon below.
* TRACEABLE OPIOID MATERIAL, TOM KITS, and the TOM KITS Logo are marks of the U.S. Department of Health and Human Services
Apply Today
First Name
Enter first name
Last Name
Enter last name
Instuon
Enter organizaon

Enter email
Verify Email
Verify email
Telephone
Enter telephone
Quanty Requested
Enter a number
Does your laboratory have a current DEA registraon to handle scheduled substances?
Please Select

Form Approved
OMB No. 0923­0047
Exp. Date 01/31/2022
Which of the following best describes your laboratory?
Please Select

Which of the following tests or services are performed by your laboratory? (Select all that apply)
Seized drug sample tesng
Post­mortem toxicology sample tesng
Workplace drug screening
Newborn drug screening
Drug pharmacology and pharmacokinecs research
Clinical tesng for disease diagnosis and treatment
Other (please specify)

On average, how many opioid­related samples does your laboratory analyze on a weekly basis?
Please Select

Which of the following analycal techniques do you perform in your laboratory? (Select all that apply)
Immunoassay
Infrared Spectroscopy
Nuclear Magnec Resonance Spectroscopy
Raman Spectroscopy
X­ray Diffracon
Chromatographic Separaon
UV/Vis
Other (please specify)

Which matrix type does your laboratory analyze? (Select all that apply)
Blood
Urine
Other (please specify)

What sample sizes are being tested?
<0.1 mL
0.1­0.5 mL
>0.5 mL
Other (please specify)

CDC esmates the average public reporng burden for this collecon of informaon as 6 minutes per response, including the me for
reviewing instrucons, searching exisng data/informaon sources, gathering and maintaining the data/informaon needed, and compleng
and reviewing the collecon of informaon. An agency may not conduct or sponsor, and a person is not required to respond to a collecon of
informaon unless it displays a currently valid OMB Control Number. Send comments regarding this burden esmate or any other aspect of
this collecon of informaon, including suggesons for reducing this burden to CDC/ATSDR Informaon Collecon Review Office, 1600
Cli,on Road NE, MS D­74, Atlanta, Georgia 30333; ATTN: PRA (0923­0047)
Submit

CAYMAN CHEMICAL

About Us
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Contact Us

CONFERENCES

Conference Schedule
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TOOLS & RESOURCES

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Attachment 6. Traceable Opioid Material* Kits Questions (Online Example 2)
Log In | Recently Purchased | Favorites | My COAs |

Cart (0)

If you represent a business that is located in the United States and would like to participate in the free Opioid CRM Program, complete the request
below.

Labs requesting free Opioid CRM Kits are required to:
• Be located in the US
• Be a legitimate and verifiable business, universities or public agencies
• Have a valid DEA Registration prior to shipment
• Have a verifiable business address
To request one or more Opioid CRM Kits, please ensure your lab meets the requirements stated above and complete the application below.

* Required Field

Contact Information
* Full Name
* Title/Position
* Email
* Telephone
Cerilliant Account Number, If Known:

Company Shipping Address (Shipping address must match address listed on DEA registration)
* Laboratory Name
* Attention
* Street Address 1
Street Address 2
* City
* State/Province

Alabama

* ZIP/Postal Code
* Country

Select Country

DEA Registration
US DEA Registration is required prior to shipment. Please provide the information requested below about the status of your DEA Registration.

* Does your laboratory have the required DEA Registration?

Select...

If Yes, enter the DEA Registration Number
* Quantity of Opioid CRM Kits Requesting:

Form Approved OMB
No. 0923-0047
Exp. Date 01/31/2022

Opioid CRM Kits Application Questions
Please provide the information below so that your request can be processed quickly.

1. Which of the following best describes your laboratory? (Select only one)
Academic Research Laboratory

Environmental Laboratory
Government Crime Laboratory
Government Toxicology Laboratory
Private or Public Clinical Laboratory
Other (please specify below)

2. Which of the following tests or services are performed by your laboratory? (Select all that apply)
Seized drug sample testing
Post-mortem toxicology sample testing
Workplace drug screening
Newborn drug screening
Drug pharmacology and pharmacokinetics research
Clinical testing for disease diagnosis and treatment
Other (please specify below)

3. On average, how many opioid-related samples does your laboratory analyze on a weeklybasis?
<100
101-500
501-1000
>1000

4. Which of the following analytical techniques do you perform in your laboratory? (Select all that apply)
Immunoassay
Infrared Spectroscopy
Mass Spectrometry
Nuclear Magnetic Resonance Spectroscopy
Raman Spectroscopy
X-ray Diffraction
Chromatographic Separation
UV/Vis
Other (please specify below)

5. Which matrix type does your laboratory analyze? (Select all that apply)
Blood
Urine
Other (please specify below)

6. What sample sizes are being tested? (Select all that apply)
<0.1 mL
0.1-0.5 mL
>0.5 mL
Other (please specify below)

CDC estimates the average public reporting burden for this collection of information as 6 minutes per response, including the time for reviewing
instructions, searching existing data/information sources, gathering and maintaining the data/information needed, and completing and reviewing the
collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it
displays a currently valid OMB Control Number. Send comments regarding this burden estimate or any other aspect of this collection of information,
including suggestions for reducing this burden to CDC/ATSDR Information Collection Review Office, 1600 Clifton Road NE, MS D-74, Atlanta, Georgia
30333; ATTN: PRA (0923-0047)

Additional Information or Comments

Cancel

Submit

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