Get Deppb License Renewal Form - Kentucky: Cabinet For Health And ...

Filling out the DEPPB License Renewal Form is a crucial step for maintaining compliance with state regulations regarding controlled substances. This guide provides step-by-step instructions on how to accurately complete the form online, ensuring a smooth renewal process.

Follow the steps to complete your license renewal form online.

1. Click the ‘Get Form’ button to download the form and open it in your document editor.
2. Begin by reading the instructions on the form. Ensure you understand the requirements and have the necessary information ready for completion.
3. In Section 1, indicate whether you are applying for a Manufacturer’s or Wholesaler’s license by checking the appropriate box.
4. In Section 1b, check all applicable schedules that pertain to your license (e.g., II, III, IV, V) to specify the types of controlled substances you will handle.
5. Section 2 requires you to fill in the name of the licensee, address, telephone number, and email. Make sure all information is accurate and up-to-date.
6. List all trade or business names in Section 3 as applicable to your operations.
7. Section 4 focuses on the contact person(s) responsible for handling, storage, and recordkeeping of controlled substances. Include their names, addresses, telephone numbers, and email addresses.
8. For Section 5, indicate the type of ownership (Individual/Sole Proprietorship, Partnership, Limited Liability Company, or Corporation) and provide the required details based on your business structure.
9. In Section 6, describe your business operations, physical facilities, and security measures. Attach additional pages if necessary.
10. You will need to enter your DEA number and its expiration date in Section 7. Make sure to attach a current DEA Registration Certificate.
11. Answer the questions in Sections 8 and 9 regarding any past convictions. Attach explanations if applicable.
12. Finally, certify the accuracy of your application by providing your printed name, title, signature, and date where indicated.
13. Once all sections are completed, review the form for any errors. Save your changes, download a copy, and print it for submission if necessary.

Complete your DEPPB License Renewal Form online today to ensure compliance and maintain your license.