DEA Form 225A Renewal Application for Registration

Under the Controlled Substances Act

Save time - renew on-line at www.deadiversion.usdoj.gov

INSTRUCTIONS

1. To renew by mail complete this application. Keep a copy for your records.
2. Mail this form to the address provided in Section 6 or use enclosed envelope.
3. The "MAIL-TO ADDRESS" can be different than your "PLACE OF BUSINESS" address.
4. If you have any questions call 800-882-9539 prior to submitting your application.

MAIL-TO ADDRESS

Form Expires: 9/30/2021

DEA#
REGISTRATION EXPIRES:
FEE IS NON-REFUNDABLE

IMPORTANT: DO NOT SEND THIS APPLICATION AND RENEW ON-LINE.

SECTION 1

APPROVED 0MB NO 1117-00 12
FOR M DEA- 225A (0 7- 19)

RENEWAL APPLICATION FOR REGISTRATION

Form-225A
Renewal

Please print mailing address changes to the right of the address in this box.

UPDATE REGISTRATION INFORMATION - Please fill in missing information and make corrections if needed to any data we have on record for your registration.

Name 1:

Name 2:

PLACE OF
l;l.l)SINESS

:Street
Address
Line 1:

PLACE OF
BUSINESS

Address
Line 2:
City
State :
Zip

Business Phone Number:

Cell Phone Number:
EMAIL
Address

Point of
Contact:
DEBT COLLECTION
INFORMATION

Mandatory pursuant
to Debt Collection
Improvements Act

SECTION 2
A.

SCHEDULES

Tax Identification Number
(if registration is for business)

Social Security Number

(if registration is for individual)

Provide SSN or TIN.

See additional information
note #3 on page 4.

Check this box if you wish to register for the same schedule(s):

Check this box if you require official order forms:

L.J

NO CHANGE

For purchase of schedule 2controlled substances

-OR----------------------------------------------------------------------------

CHANGE

If you want to make a change, check all the schedules that you are requesting for this registration:
Schedule 1

Enter specific drug
codes on page 2.

Schedule 2Narcotic

Schedule 3 Narcotic

Schedule 4

Schedule 2Non-Narcotic ( 2N)

Schedule 3 Non-Narcotic (3N)

Schedule 5

B.

MANUFACTURER

ONLY
Mark each box with
an 'X' to indicate
which schedule is
handled in each
manufacturing stage.

STAGE1
Bulk synthesis/extraction
STAGE2
Dosage form manufacture

STAGE3
Package / Repackage
/ Relabel
Label
STAGE4
Non-human consumption
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