
DEA FORM106Report of Theft or Loss of Controlled Substances OMB No. 11170001 (Exp. Date 7/31/2023)Type of Report: (check one box only) 1.New ReportU.S. Department of Justice Drug Enforcement Administration Diversion.
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How to fill out the DoJ DEA-106 online
The DoJ DEA-106 form is essential for reporting theft or loss of controlled substances. This guide provides clear, step-by-step instructions to help users complete the form accurately and efficiently.
Follow the steps to fill out the DoJ DEA-106 form online.
- Click ‘Get Form’ button to obtain the form and open it in the editor.
- Indicate the type of report by checking one of the boxes: 'New Report' or 'Amendment Key'. Fill in the date of the previous report if applicable.
- Enter your DEA registration number, business name, and the address details including city, state, and ZIP code.
- Provide the point of contact information, including their name, email address, and phone number.
- Record the date of the theft or loss or when it was first discovered, and state the number of thefts or losses experienced in the past 24 months.
- Select the principal business type from the provided options like 'Pharmacy', 'Practitioner', 'Manufacturer', etc.
- If applicable, indicate the type of theft or loss, such as 'Loss in Transit', and fill out the relevant details including the name and phone number of the common carrier.
- If this was a robbery, indicate if any individuals were injured or killed, and provide the name of the police department and the police report number.
- List corrective measures taken to prevent future thefts or losses, such as installing security systems or terminating employees.
- List the stolen or lost controlled substances with all required details including trade names, NDC numbers, and total quantities.
- Provide any remarks or additional descriptions regarding the circumstances of the theft or loss.
- Sign the form electronically, certifying that the information provided is true and correct, and enter the date signed.
- Finally, review all entries, make any necessary changes, and choose to save, download, print, or share the form.
Complete your DoJ DEA-106 form online today for accurate reporting of controlled substances.
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