DEA Registration Controlled Substances Act Data-Use Requ

Drug Enforcement Administration Registration CSA Data-Use Request
Access to data from the Drug Enforcement Administration’s Controlled Substances Act Registration Information
Database is limited to those complying with Statutes and Rules administered by DEA, as well as other Federal, State, and
local, laws and ordinances. Please complete this form to request access to the dataset from the DEA Controlled
Substances Act Registration Information Database. The form must be completed in its entirety. Completed form and
any supporting documentation must be emailed to [email protected].
Type of request (please check one):

New Account [ ]

Renewal of an Existing Account [ ]

Company Name: _______________________________ Your Company Email Address: __________________________
(This will be your username)

First Name: ____________________

Middle Name: ____________________

Last Name: ____________________

Address 1 (PO Boxes not accepted):____________________________________________________________________
Address 2: ________________________________________________________________________________________
City: ________________________________________
Phone: ______________________________

State: __________

Zip: __________

Zip+4: __________

Extension: ____________________

Agency or Company Type (please check): Federal/State Government/Law Enforcement [ ]
Is this request for a State Prescription Drug Monitoring Program (PDMP/PMP)?

[ ] No

Private Company [ ]

[ ] Yes - State: __________

Category you are applying for:
[ ]

Online Validation Tool
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[ ]

Full Dataset Download*

[ ]

Both*

Parent organizations of those entities registered under the Controlled Substance Act.
Entities with Federal or State statutory requirements.
Entities providing credentialing or verification services to the Pharmaceutical and Healthcare industry.

[ ] Limited Dataset Download (Does not contain DEA Numbers or Expiration Dates)*
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For those that do not fall into the above category but can demonstrate a Need-to-Know.

* Please note that the Full and Limited Dataset Downloads require a self-designed database type system, a system
designed by your organization, to efficiently use the downloaded file.

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Drug Enforcement Administration Registration CSA Data-Use Request
Justification: Describe in detail, your organization, and how the information will be used. Include Federal and/or
State statutory requirements. If requesting to download the dataset, articulate the security measures you take to
keep the data secure.

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Drug Enforcement Administration Registration CSA Data-Use Request
DEA Registration Dataset Data-Use Agreement
In order to process your request for access to the DEA Controlled Substances Act Registration Information Database
and the dataset contained within, you must agree to the following provisions.
The Drug Enforcement Administration is the owner of the DEA Controlled Substances Act Registration Information
Database, and the dataset contained within. Access to the DEA Controlled Substances Act Registration Information
Database, and the dataset contained within, is limited to those registered with, or by request to, the Drug Enforcement
Administration in order to comply with Federal, State, and local, Statutes and Rules.
The unauthorized distribution, reverse engineering, re-engineering, profit from the sale, the incorporation in a
software system or package for distribution, or the use for marketing and/or targeting, are strictly forbidden and not
allowed uses of the dataset from the Controlled Substances Act Registration Information Database.
By your acknowledgement below, you agree to the following:
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Information contained within the dataset will only be used for the purposes described in the justification section
within this application.
Intentional misuse of the information contained within the dataset to include: use other than that described in the
justification section, unauthorized distribution, reverse engineering, re-engineering, profit from the sale, the
incorporation in a software system or package for distribution, or the use for marketing and/or targeting, are
subject to civil and/or criminal prosecution.
Agree to protect access to the information to prevent any unauthorized use thereof.
Agree to notify DEA within 24 hours if any provided data is breached and/or disclosed to unauthorized persons.
Agree to protect the information from any further dissemination and/or unauthorized use.
Access to the DEA Controlled Substances Act Registration Information Database, and the dataset contained within,
is issued on an annual basis. Access must be applied for annually.

My signature confirms that I have read, understand the information, and agree to the terms outlined above.
(Signatures must be a certifiable digital or pen signed signature. Other types are not acceptable.)
Signature: ___________________________________________________

Date: _______________________________

Printed name: ________________________________________________

Title: _______________________________

WARNING: 21 USC 843(d), states that any person who knowingly or intentionally furnishes false or fraudulent
information in the application is subject to a term of imprisonment of not more than 4 years, and a fine under Title 18 of
not more than $250,000, or both.
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