Form DEA-251 CSOS DEA Registrant Certificate Application

Instructions for completing DEA Form 251
CSOS DEA Registrant Certificate Application Instructions
Introduction:
Form DEA-251 is for DEA Registrants requesting a CSOS digital certificate for electronic
ordering of controlled substances. A DEA Registrant is the individual who signed the most
recent application for DEA Registration or the individual authorized to sign the most recent
application for DEA Registration. Only DEA Registrants may submit a CSOS DEA Registrant
Certificate Application. All other individuals requesting the ability to sign electronic orders for
controlled substances must enroll in the CSOS program as either a Coordinator (Form DEA-252)
or Power of Attorney (Form DEA-253).
Completing the application:
The information must be TYPED electronically into the PDF form on-line with the exception
of signatures, affirmations and the notary acknowledgement sections, which must be completed
in blue or black ink. All fields must be completed.
The Registrant applicant must name him/herself as Coordinator or delegate the role to another
Principal Coordinator applicant or existing subscriber.
The applicant should review the CSOS DEA Registrant Certificate Application Checklist to
ensure all required documents are included with his/her application prior to mailing the
application package to the CSOS Registration Authority.
Mail the completed applications and their attachments to one of the following:
Drug Enforcement Administration
Sterling Park Technology Center / CSOS
8701 Morrissette Drive
Springfield, VA 22152

Please contact DEA Diversion E-Commerce Support for enrollment assistance.
Phone: 1-877-DEA-ECOM (1-877-332-3266)
E-mail: [email protected]

Instructions for completing DEA Form 251
CSOS DEA Registrant Certificate Application Instructions
What the applicant will receive:
DEA Registrant applicants will receive one CSOS Signing Certificate for each DEA Registration
number enrolled. In addition to receiving a CSOS Signing Certificate for each DEA Registration
number identified, each Registrant applicant will be issued one CSOS Administrative Certificate
if serving the role of Coordinator.
The applicant will receive a pair of activation notices for each certificate issued.
•
•

An E-mail activation notice will be sent for each certificate, which will contain an Access
Code unique to that certificate
A postal mailed activation notice will be sent for each certificate, which will contain an
Access Code Password unique to that certificate as well as information for logging in to
DEA’s secure certificate retrieval Web site

The codes must be entered on the DEA E-Commerce Web site in order to retrieve the digital
certificate.

Please contact DEA Diversion E-Commerce Support for enrollment assistance.
Phone: 1-877-DEA-ECOM (1-877-332-3266)
E-mail: [email protected]

Instructions for completing DEA Form 251
CSOS DEA Registrant Certificate Application Instructions
Section 1 – Applicant Information (All fields required)
Field Name
Applicant Last Name
Applicant First Name
MI
Applicant Social
Security Number
Applicant Bus. Phone

Applicant E-mail
Address
DEA Registration No.

DEA Registrant Name

Security Code
No. of Addendums

Applicant Business
Address
CSOS Coordinator
Last Name
CSOS Coordinator
First Name

Information Description
Enter the last name of the Registrant applicant.
Enter the first name of the Registrant applicant.
Enter the middle initial of the applicant. Enter ‘X’ if the applicant does
not have a middle initial.
Enter the Social Security Number of the applicant. This information
will be kept private and used for internal purposes as stated in the
Privacy Policy.
Enter the business phone number for the applicant. This phone number
will be kept private and will be used only when necessary for
correspondence concerning your CSOS application or CSOS
Certificate(s).
Enter the individual E-mail address for the applicant, which must not be
the same E-mail address as any other applicant. This E-mail address
will be kept private and will be used for correspondence concerning
your CSOS application or CSOS Certificate(s).
Enter the DEA Registration Number for which the applicant is
requesting electronic ordering ability and, if indicated, Principal
Coordinator status. The number entered on the application MUST
appear as it does on the associated DEA Registration Certificate.
Inconsistency between the application and the registration certificate
will result in approval delays or denial.
Enter the name of the DEA Registered location as it appears on the
DEA Registration Certificate (Form 223). Inconsistency between the
application and Registration Certificate will result in approval delays or
denial.
Enter a security code for the applicant. This information will be kept
private and used for authentication purposes. Use letters only. Do not
include any numbers.
Enter the number of CSOS Certificate Application Registrant List
Addendums (Form DEA-254) submitted. Enter ‘0’ if no addendum
forms are attached. DEA Registrant List Addendums allow applicants
to enroll for Certificates for additional DEA Registration numbers.
Enter the business address of the CSOS Coordinator applicant. This
address may be used for correspondence concerning CSOS Certificate
applications, renewals, and revocations.
Enter the last name of the individual who will fulfill the role of Principal
Coordinator for the DEA Registration number(s) identified. Enter the
last name of the Registrant applicant if he/she is to fulfill the role of
Principal Coordinator.
Enter the first name of the individual who will fulfill the role of
Principal Coordinator for the DEA Registration number(s) identified.
Enter the first name of the Registrant applicant if he/she is to fulfill
the role of Principal Coordinator.

Please contact DEA Diversion E-Commerce Support for enrollment assistance.
Phone: 1-877-DEA-ECOM (1-877-332-3266)
E-mail: [email protected]

Instructions for completing DEA Form 251
CSOS DEA Registrant Certificate Application Instructions
Section 2 – Applicant Signature (individual whose name appears in Section 1)
Applications that have not been signed will be denied and returned immediately.
Field Name
Applicant
Signature, Date

Information Description
The Registrant applicant must sign and date the application using blue
or black ink in the presence of a certified notary public. The party
signing this application must be the same party listed in Section 1 –
Applicant Information (First Name/Last Name/MI).

Section 3 – Notary Acknowledgement
Field Name
Notary
Acknowledgement

Information Description
A CERTIFIED NOTARY PUBLIC must complete the Acknowledgement
section using blue or black ink. All fields in this section, including the
notary seal/stamp, must be completed. The Registrant applicant must sign
the application in the presences of the CERTIFIED NOTARY PUBLIC.
It is the responsibility of the applicant to ensure that all information is
completed.

Warning: When the applicant signs the application, he/she is stating that he/she has read,
understood, and agreed to abide by the rules and regulations contained in the Controlled
Substance Ordering System Subscriber Agreement and Certificate Policy. He/she is certifying
that the information, statements and representations provided by him/her on the application are
true and accurate to the best of his/her knowledge. He/She understands that presenting false
information is a criminal offense and is punishable by law. Section 843(a)(4)(A) of Title 21,
United States Code, states that any person who knowingly or intentionally furnishes false or
fraudulent information in the application is subject to imprisonment for not more than four years,
a fine of not more than $30,000.00 or both.
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 control number for the
collection of this information is 1117-0038. Public reporting burden for this collection of information is
estimated to average 1.5 hours, including time for reviewing instructions, searching existing data sources,
gathering and maintaining the data needed, and completing and reviewing the collection of information.

Please contact DEA Diversion E-Commerce Support for enrollment assistance.
Phone: 1-877-DEA-ECOM (1-877-332-3266)
E-mail: [email protected]

DEA-251 (Expires: July 31, 2022)

Approved OMB
NO.1117-0038

CSOS DEA Registrant Certificate Application

This application must be completed by the individual who signed the most recent application for DEA Registration (DEA Registrant) or the
individual authorized to sign the most recent DEA Registration application. Read instructions before completing. ALL FIELDS ARE REQUIRED.

Section 1 – Applicant Information
Applicant Last Name

Applicant First Name

MI

Applicant SSN Number

Applicant Bus. Phone

Applicant E-Mail Address

DEA Registration No.

DEA Registrant Name

Security Code (e.g. Mother’s Maiden Name) Letters only. Remember this code to ensure proper identification when you call the Support Desk. No. of Addendums

Applicant Business Address

City

State

Zip

CSOS Coordinator Last Name (Required - enter either CSOS DEA Registrant applicant or form DEA-252 must be submitted by individual named below)

CSOS Coordinator First Name (Required - enter either CSOS DEA Registrant applicant or form DEA-252 must be submitted by individual named below)

Section 2 – Applicant Signature
By signing this document, I am stating that I have read, understand and agree to abide by the rules and regulations contained in the Controlled Substance Ordering
System Subscriber Agreement and CSOS DEA Registrant Agreement. I am also certifying that the information, statements, and representations provided by me on
this form are true and accurate to the best of my knowledge. I understand presenting false information is a criminal offense and is punishable by law.
Section 843(a)(4)(A) of Title 21, United States Code, states that any person who knowingly or intentionally furnishes false or fraudulent information in the
application is subject to imprisonment for not more than four years, a fine of not more than $30,000.00 or both.

Applicant Signature ______________________________________________________________________ Date ___________
ddffffffffffffffffffffffffffffffffffffffffffd
Note: This application will be denied and returned if not signed and dated by the DEA Registrant Applicant listed in Section 1.

Section 3 –– Notary Acknowledgement
Instructions to Notary: 1. Modify this form where necessary to assure compliance with the laws of your jurisdiction. Use the back of
the form if necessary. 2. Notary must fully complete the Acknowledgement below 3. Sign and seal/stamp the Application form.
4. Identification #1 must be a government-issued, widely recognized form of photo ID, such as Driver's License or Passport. ID #2 does not
require a photo, but must be a different form of ID. Examples: Valid government issued ID, employee ID card, utility or tax bill, major
insurance card, or state pharmacist ID.
State or Commonwealth of ______________________ County of______________________ Country_______________
On______________________ before me,_________________________ personally appeared
________________________________(Applicant) proved to me on the basis of the presentation of two forms of identification listed below
to be the person whose name is subscribed to the within instrument and acknowledged to me that he/she executed the same, and that by
his/her signature on the instrument the person executed the instrument in my presence.
ID #1 (with photograph)
ID #2

Type:____________ Identifying Number:________________ Expiration Date:__________
Type:____________ Identifying Number:________________ Expiration Date:__________

Witness my hand and official seal.
Notary's Signature:_____________________________________________________________________________
Notary's Name (Print or Type):___________________________________________________________________
Notary's Address:_______________________________________________________
Notary's Phone:_______________________ My Commission Expires:_____________

Notary Stamp/Seal

Instructions for completing DEA Form 251
CSOS DEA Registrant Certificate Application Instructions
Use the following checklist to ensure that your enrollment package is complete. Incomplete
applications will be returned if the requested missing items are not supplied within 90 days.
All DEA Registration numbers listed are valid for ordering Schedule I and/or II
substances.
The Registrant applicant has read, understood, and agreed to the CSOS DEA Registrant
Agreement, the CSOS Subscriber Agreement, and the CSOS Privacy Policy.
The Registrant applicant must mail all of the following documents to the CSOS Registration
Authority
Form DEA-251 – the original, completed, signed, and notarized CSOS DEA Registrant
Certificate Application
All fields have been completed – there are no optional fields
The Registrant applicant’s E-mail address is a personal account, not shared with
any other individual applicant
The Registrant applicant has indicated that he/she will fulfill the role of CSOS
Coordinator, or has delegated the role to another individual
The application has been signed in the presence of a notary
The application has been notarized
Form DEA-223 – a clearly readable photocopy of the DEA Registration certificate for
each DEA Registration number identified on the CSOS DEA Registration Certificate
Application and Registrant List Addendum
Registrant Applicant Identifications – photocopies of two clearly readable forms of ID.
One form of ID must be a Government-issued photo ID such as a driver’s license or
passport; the second form of ID does not require a photo and can be anything except for a
credit card.
Addendums (Form DEA-254) – only required if the Registrant applicant is to be
Registrant for more than one location. Each additional location must be indicated on the
CSOS Certificate Registrant List Addendum (Form DEA-254). One CSOS Signing
Certificate will be issued to the Registrant for each DEA registration number. Please
contact DEA E-Commerce Support if enrolling for more than 50 DEA Registrations.

Please contact DEA Diversion E-Commerce Support for enrollment assistance.
Phone: 1-877-DEA-ECOM (1-877-332-3266)
E-mail: [email protected]

Instructions for completing DEA Form 251
CSOS DEA Registrant Certificate Application Instructions
For all carriers, mail the complete application package to:
Drug Enforcement Administration
Sterling Park Technology Center / CSOS
8701 Morrissette Drive
Springfield, VA 22152

Please contact DEA Diversion E-Commerce Support for enrollment assistance.
Phone: 1-877-DEA-ECOM (1-877-332-3266)
E-mail: [email protected]