Get Instructions For Registration And Certification For Euthanasia Of Animals - Health Ny

Filling out the Instructions For Registration And Certification For Euthanasia Of Animals is essential for incorporated societies and municipal animal control facilities engaged in euthanasia activities. This guide provides a clear, step-by-step walkthrough to help you complete the form accurately and efficiently online.

Follow the steps to complete the registration and certification process.

1. Click the ‘Get Form’ button to access the form. This will open the form in your chosen editor for you to begin filling it out.
2. Indicate whether you are submitting a new application or a renewal by checking the appropriate box. If renewing, include your certificate number.
3. Fill out the Facility Information section, including the facility name, address (street address, city, state, and zip code), telephone number, county, federal employer number (EIN), and DEA registration number.
4. Provide Agent Information by entering the name and address of the registered agent, including their contact telephone number.
5. In the Euthanasia Technician Information section, enter the names and certificate numbers of individuals to whom controlled substances will be dispensed. Use an additional sheet if needed.
6. Detail the safeguards for controlled substances, specifying that they will be stored in a securely locked cabinet. Describe the cabinet's specifications, location, and locking mechanism.
7. List your controlled substance distributors, ensuring they hold a Class 2 or Class 2A Distributor License from New York State.
8. Complete the Applicant Affirmation and Signatures section. Answer all questions, and if applicable, submit supporting documentation. Ensure both the applicant (or authorized representative) and the agent sign and date the application.
9. After completing the form, make a copy for your records. Then, mail the application along with all required supporting documentation to the Bureau of Narcotic Enforcement.

Start completing your registration and certification documents online today.