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URL:	https://www.deadiversion.usdoj.gov/...s/surrend/surrend.html
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Modified:	2024-05-29 08:46:58
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Title:	Diversion Control Division | Registrant Record of Controlled Substances Destroyed - DEA Form 41
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Keywords:	Diversion Control Division
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Body:	DEA.Registration.Help@dea.gov 1.800.882.9539 Search Home About Us Program Description Customer Service Plan DEA Forms & Applications Mailing Addresses Meeting & Events Privacy Notice What's New Registration Registration CMEA Required Training & Self-Certification Quota Applications Marihuana Growers Information Schedule I Controlled Substances Research Information Notice of Registration Reporting ARCOS BCM Online Chemical Import/Export Declarations CSOS Theft/Loss Reporting Import/Export Medical Missions Quotas Registrant Record of Controlled Substances Destroyed Regulated Machines (Tableting and Encapsulating) Reports Required by 21 CFR SORS Submit a Tip to DEA Year-end Reports Resources Administrative Actions Chemical Control Program CMEA (Combat Meth Epidemic Act) Controlled Substances Schedules DEA Regulatory Priorities DEA TOX Drug Disposal Information Drug & Chemical Information EPCS (Electronic Prescriptions for Controlled Substances) Federal Register Notices Guidance Document Portal Medications for Opioid Use Disorder National Prescription Drug Take Back Day NFLIS OPIOID (PHE) Information Publications & Manuals Questions & Answers Telemedicine Title 21 Code of Federal Regulations Title 21 USC Codified CSA Contact Us Registrant Record of Controlled Substances Destroyed - DEA Form 41 Home Reporting Registrant Record of Controlled Substances Destroyed - DEA Form 41 Destruction of Controlled Substances IMPORTANT NOTICE: Only those persons registered with and authorized by DEA to handle controlled substances may utilize/submit this form. Registrant Record of Controlled Substances Destroyed - DEA Form 41 (PDF) INSTRUCTIONS Registrant Record of Controlled Substances Destroyed - DEA Form 41 It is recommended that registrants review 21 CFR §1317 - Disposal Section A. REGISTRANT INFORMATION: The registrant destroying the controlled substance(s) shall provide their DEA registration number and the name and address indicated on their valid DEA registration, in addition to a current telephone number and a contact name, if different from the name on the valid DEA registration. Section B. (1) Inventory: This part shall be used by registrants destroying lawfully possessed controlled substances, other than those described in Section B(2). In each row, indicate the National Drug Code (NDC) for the controlled substance destroyed, or if the substance has no NDC, indicate the DEA Controlled Substances Code Number for the substance; if the substance destroyed is in bulk form, indicate the batch number, if available. In each row, indicate the name, strength, and form of the controlled substance destroyed, and the number of capsules, tablets, etc., that are in a full package (pkg. qty.). If destroying the full quantity of the controlled substance, indicate the number of packages destroyed (number of full pkgs.). If destroying a partial package, indicate the partial count of the capsules, tablets, etc. destroyed (partial pkg. count). If destroying a controlled substance in bulk form, indicate that the substance is in bulk form (form) and the weight of the substance destroyed (pkg. qty.). In each row, indicate the total number of each controlled substance destroyed (total destroyed). Section B. (2) Collected Substances: This part shall be used by registrants destroying controlled substances obtained through an authorized collection activity in accordance with 21 U.S.C. 822(g). In each row, indicate whether registrant is destroying a mail-back package or an inner liner. If destroying a mail-back package, enter each unique identification number separated by a comma and/or as a list in a sequential range and total quantity of packages being destroyed. If destroying an inner liner, enter each unique identification number separated by a comma and/or as a list in a sequential range based on the size of the liners destroyed and the total quantity of inner liners being destroyed. In the case of mail-back packages or inner liners received from a law enforcement agency which do not have a unique identification number or clearly marked size, include the name of the law enforcement agency and, if known, the size of the inner liner or package. DO NOT OPEN ANY MAIL-BACK PACKAGE OR INNER LINER; AN INVENTORY OF THE CONTENTS OF THE PACKAGES OR LINERS IS PROHIBITED BY LAW AND IS NOT REQUIRED BY THIS FORM. If additional space is needed for items destroyed in Section B, attach to this form additional page(s) containing the requested information for each controlled substance destroyed. Section C. METHOD OF DESTRUCTION: Provide the date, location, and method of destruction. The method of destruction must render the controlled substance to a state of non-retrievable and meet all applicable destruction requirements. Section D. WITNESSES: Two authorized employees must declare by signature, under penalty of perjury, that such employees personally witnessed the destruction of the controlled substances listed in Section B in the manner described in Section C. You are not required to submit this form to DEA, unless requested to do so. This form must be kept as a record of destruction and be available by the registrant for at least two years in accordance with 21 U.S.C. 827. Paperwork Reduction Act Statement: The information collected on this form is necessary for DEA registrants to record controlled substances destroyed in accordance with the Controlled Substances Act (CSA). The records that DEA registrants maintain in accordance with the CSA must be kept and be available, for at least two years, for inspection and copying by officers or employees of the United States authorized by the Attorney General. 21 U.S.C. 827. DEA estimates that it will take approximately 30 minutes to complete this form, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. The completion of this form by DEA registrants that destroy controlled substances is mandatory in accordance with 21 U.S.C. 827. Please note that an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Comments regarding this information collection, including suggestions for reducing the burden estimate, should be directed to the Drug Enforcement Administration, DEA Federal Register Representative/ODL, 8701 Morrissette Drive, Springfield, Virginia 22152. REGISTRATION REPORTING RESOURCES CONTACT US PRIVACY NOTICE GET EMAIL UPDATES Get Email Updates × Official U.S. Department of Justice Seal The United States Department of Justice You are now leaving a Department of Justice Web site. You are about to access: Email Updates The Department of Justice does not endorse the organizations or views represented by this site and takes no responsibility for, and exercises no control over, the accuracy, accessibility, copyright or trademark compliance or legality of the material contained on this site. Thank you for visiting our site. DEA.GOV JUSTICE.GOV USA.GOV REGULATIONS.GOV DOJ Privacy Policy Section 508 Accessibility DOJ Legal Policies & Disclaimers FOIA DIVERSION CONTROL DIVISION U.S. Department of Justice Drug Enforcement Administration DIVERSION CONTROL DIVISION 8701 Morrissette Drive Springfield, VA 22152 1.800.882.9539