Application for Permit to Export Controlled Substances--DEA Form 161

INSTRUCTIONS AND INFORMATION, DEA-161

This application must be completed in triplicate. Original is sent to DEA. See instruction (7) for copies two and three.
(1) The name and address of the consignee as shown on this application and on the permit to export must correspond
with that shown on the foreign import certificate.
(2) To avoid delays in clearance at the port of export be sure to enter the correct port on this application. A copy of your
export permit is sent directly to the District Director of Customs at the port indicated on the application for comparison
with the permit presented for clearance of the shipment. The shipment will not clear at any other port without an
amendment of the permit indicating a change to that effect.
(3) The original or an authentic signed and/or notarized copy of the foreign import certificate must accompany this

application. If this certificate is needed to accomplish entry of the drug into the country of destination, your request
for its return to you should accompany the application.
(4) Application should be made in the name of the registered legal entity, as shown on the DEA registration certificate, and

signed by a responsible authorized official if a corporation, by a partner, or by the person registered as an individual.
Only persons registered as exporters may be issued export permits. The registrations of manufacturers, distributors,
practitioners, researchers, etc., do not entitle them to export controlled substances.
(5) Permits will be mailed to the exporter at the address shown at the bottom of the application unless contrary instructions

are attached to and made a part of this application.
(6) Identification of drugs to be exported and the controlled substance content should be entered on the application in the

following manner:
7a. NAME AND QUANITY OF DRUG OR PREPARATION
TO BE EXPORTED

7B. CONTROLLED SUBSTANCE CONTENT OF DRUG OR PREPARATION
TO BE EXPORTED (expressed as acid, base or alkaloid, not salt)

3 bottles x 100 Secobarbital Sodium capsules (100 mg./capsule)

Secobarbital

27.47 Gm.

2 boxes x 100 Medperidine HCL ampules (5%, 2ml. ampules)

Meperidine

17.43 G.m

1 box x 100 Meperidine HCL vials (10%, 20 ml, vials)

Meperidine

174.30 Gm.

2 x 1 Pt. Meperidine HCL Syrup (50 mg./5ml., pints)

Meperidine

1 box x 100 gm. Dextroamphetamine Sulfate powder

Dextroamphetamine

1 bottle x 500 Hydromorphone HCl tablets (4 mg./tablets)

Hydromorphone

8.24 Gm.
73.38 Gm.
1.77 Gm.

(7) The following information must be entered in block 7c at the time of export: (1) DEA Export Permit Number
and (2) actual quantity and date shipped. Copy 2 is sent to DEA, and Copy 3 is retained by the registrant.

PRIVACY ACT INFORMATION
AUTHORITY: Section 1003 of the Controlled Substances Act of 1970 (PL 91-513).
PURPOSE: Control exportation of certain Controlled Substances into the United States.
ROUTINE USES: The Controlled Substances Act Registration Records produces special reports as required
for statistical 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 regulatorypurposes.
C. Persons registered under the Controlled Substances Act (Public Law 91-513)
for the purpose of verifying the registration of customers and practioners.

EFFECT: No permit will be issued.
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a Collection of Information
unless it displays a valid OMB control number. The valis OMB control number for this Information Collection is
1117-0004. The time required the complete this information collection is estimated to average 15 minutes per response,
including the time to review instructions, search existing data resources, gather the data needed, and complete and
review the information collection.