Get Doj Dea-106 2019-2026

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.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. 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.
3. Enter your DEA registration number, business name, and the address details including city, state, and ZIP code.
4. Provide the point of contact information, including their name, email address, and phone number.
5. 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.
6. Select the principal business type from the provided options like 'Pharmacy', 'Practitioner', 'Manufacturer', etc.
7. 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.
8. 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.
9. List corrective measures taken to prevent future thefts or losses, such as installing security systems or terminating employees.
10. List the stolen or lost controlled substances with all required details including trade names, NDC numbers, and total quantities.
11. Provide any remarks or additional descriptions regarding the circumstances of the theft or loss.
12. Sign the form electronically, certifying that the information provided is true and correct, and enter the date signed.
13. 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.