Instructions for completing DEA Form 251 CSOS DEA Registrant Certificate Application Instructions

Introduction: Form DEA-251 is for DEA Registrants requesting a CSOS digital certificate for electronic ordering of controlled substances. A DEA Registrant is the individual who signed the most recent application for DEA Registration or the individual authorized to sign the most recent application for DEA Registration. Only DEA Registrants may submit a CSOS DEA RegistrantCertificate Application. All other individuals requesting the ability to sign electronic orders for controlled substances must enroll in the CSOS program as either a Coordinator (Form DEA-252) or Power of Attorney (Form DEA-253).

Completing the application: The information must be TYPED into the online form with the exception of signatures, affirmations and the notary acknowledgement sections, which must be completed in blue or black ink. All fields must be completed.

The Registrant applicant must name him/herself as Coordinator or delegate the role to another Principal Coordinator applicant or existing subscriber.

The applicant should review the CSOS DEA Registrant Certificate Application Checklist to ensure all required documents are included with his/her application prior to mailing the application package to the CSOS Registration Authority.

Mail the completed applications and their attachments to one of the following:
Drug Enforcement Administration
Sterling Park Technology Center / CSOS
8701 Morrissette Drive
Springfield, VA 22152

What the applicant will receive: DEA Registrant applicants will receive one CSOS Signing Certificate for each DEA Registration number enrolled. In addition to receiving a CSOS Signing Certificate for each DEA Registration number identified, each Registrant applicant will be issued one CSOS Administrative Certificate if serving the role of Coordinator.

The applicant will receive a pair of activation notices for each certificate issued.


The codes must be entered on the DEA E-Commerce Web site in order to retrieve the digital certificate.

Section 1 - Applicant Information (All fields required)
Field Name Information Description
Applicant Last Name Enter the last name of the Registrant applicant.
Applicant First Name Enter the first name of the Registrant applicant.
MI Enter the middle initial of the applicant. Enter 'X' if the applicant does not have a middle initial.
Applicant Social Security Number Enter the Social Security Number of the applicant. This information will be kept private and used for internal purposes as stated in the Privacy Policy.
Applicant Bus. Phone Enter the business phone number for the applicant. This phone number will be kept private and will be used only when necessary for correspondence concerning your CSOS application or CSOS Certificate(s).
Applicant E-mail Address Enter the individual E-mail address for the applicant, which must not be the same E-mail address as any other applicant. This E-mail address will be kept private and will be used for correspondence concerning your CSOS application or CSOS Certificate(s).
DEA Registration No. Enter the DEA Registration Number for which the applicant is requesting electronic ordering ability and, if indicated, Principal Coordinator status. The number entered on the application MUST appear as it does on the associated DEA Registration Certificate. Inconsistency between the application and the registration certificate will result in approval delays or denial.
DEA Registrant Name Enter the name of the DEA Registered location as it appears on the DEA Registration Certificate (Form 223). Inconsistency between the application and Registration Certificate will result in approval delays or denial.
Security Code Enter a security code for the applicant. This information will be kept private and used for authentication purposes. Use letters only. Do not include any numbers.
No. of Addendums Enter the number of CSOS Certificate Application Registrant List Addendums (Form DEA-254) submitted. Enter '0' if no addendum forms are attached. DEA Registrant List Addendums allow applicants to enroll for Certificates for additional DEA Registration numbers.
Applicant Business Address Enter the business address of the CSOS Coordinator applicant. This address may be used for correspondence concerning CSOS Certificate applications, renewals, and revocations.
CSOS Coordinator Last Name Enter the last name of the individual who will fulfill the role of Principal Coordinator for the DEA Registration number(s) identified. Enter the last name of the Registrant applicant if he/she is to fulfill the role of Principal Coordinator.
CSOS Coordinator First Name Enter the first name of the individual who will fulfill the role of Principal Coordinator for the DEA Registration number(s) identified. Enter the first name of the Registrant applicant if he/she is to fulfill the role of Principal Coordinator.
Section 2 - Applicant Signature (individual whose name appears in Section 1) Applications that have not been signed will be denied and returned immediately.
Field Name Information Description
Applicant Signature, Date The Registrant applicant must sign and date the application using blue or black ink in the presence of a certified notary public. The party signing this application must be the same party listed in Section 1 - Applicant Information (First Name/Last Name/MI).
Section 3 - Notary Acknowledgement
Field Name Information Description
Notary Acknowledgement Enter the last name of the Registrant applicant.


Warning: When the applicant signs the application, he/she is stating that he/she has read, understood, and agreed to abide by the rules and regulations contained in the Controlled Substance Ordering System Subscriber Agreement and Certificate Policy. He/she is certifying that the information, statements and representations provided by him/her on the application are true and accurate to the best of his/her knowledge. He/She understands that presenting false information is a criminal offense and is punishable by law. Section 843(a)(4)(A) of Title 21, United States Code, states that any person who knowingly or intentionally furnishes false or fraudulent information in the application is subject to imprisonment for not more than four years, a fine of not more than $30,000.00 or both.

In accordance with the Paperwork Reduction Act of 1995, no person is required to respond to a collection of information unless it displays a valid OMB control number. The OMB control number for the collection of this information is 1117-0038. Public reporting burden for this collection of information is estimated to average 1.24 hour, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.

Please contact DEA Diversion E-Commerce Support for enrollment assistance.
Phone: 1-877-DEA-ECOM (1-877-332-3266)
E-mail: CSOSsupport@deaecom.gov



CSOS DEA Registrant Certificate Application

Please generate the PDF after filling the details in the below form!

Applicant Last Name

Applicant First Name

MI Applicant SSN Number Applicant Bus. Phone
Applicant E-Mail Address

DEA Registration No. DEA Registration Name
Security Code (e.g. Mother's Maiden Name) Letters only. Remember this code to ensure proper identification when you call the Support Desk.

Applicant Business Address

City State Zip
CSOS Coordinator Last Name (Required - enter either CSOS DEA Registrant applicant or form DEA-252 must be submitted by individual named below)

CSOS Coordinator First Name (Required - enter either CSOS DEA Registrant applicant or form DEA-252 must be submitted by individual named below)


No. of Addendums: 0


 

Instructions
×

Instructions for completing DEA Form 254 CSOS Certificate Application Registrant List Addendum
Introduction:

Form DEA-254 is for individuals requesting to be enrolled for more than one DEA Registration number in the CSOS program. This Addendum form must be associated with a Registrant (DEA-251), Coordinator (DEA-252) or Power of Attorney (DEA-253) Certificate Application.

Approved Registrant, Coordinator (if requesting the ability to sign controlled substance orders), and Power of Attorney applicants will be issued a CSOS Signing Certificate for each location listed on his/her application and associated addendums. Coordinator Applicants who have not requested signing authority will be issued only one CSOS Administrative Certificate, but will be authorized fulfill the role of Coordinator for all DEA Registration Numbers listed on his/her application and associated addendums.

Bulk Enrollment:

Up to five (5) Registrant List Addendums listing a total of 50 DEA Registration Number(s) may be submitted with a Registrant, Coordinator, or Power of Attorney Certificate Application. Please contact DEA Diversion E-Commerce Support if applying with more than 50 Registrations.

Completing the application:

The information must be TYPED into the online form with the exception of signatures, affirmations and the notary acknowledgement sections, which must be completed in blue or black ink. All fields must be completed.

Registrant and Coordinator Applicants must include a photocopy of the DEA Registration Certificate (form DEA-223) for each DEA Registration Number indicated on the Registrant List Addendum.

Section 1 - Applicant Information (All fields required)
Field NameInformation Description
Applicant Last NameEnter the last name of the applicant.
Applicant First NameEnter the first name of the applicant.
MIEnter the middle initial of the applicant. Enter 'X' if the applicant does not have a middle initial.
Applicant Social Security NumberEnter the Social Security Number of the applicant. This information will be kept private and used for internal purposes as stated in the Privacy Policy.
Addendum _ of _Enter the page number of the addendum form and the total number of addendum forms included for the applicant. Example: 1 of 3, 2 of 3, 3 of 3.

Section 2 - DEA Registration List
Field NameInformation Description
DEA Registration NumEnter the DEA Registration Number(s) for which the applicant will be responsible. The number(s) entered on the application MUST appear as it does on the registrant's DEA Registration Certificate (Form DEA-223). Inconsistency between the application and the registration will result in approval delays or denial.
DEA Registration NameEnter the name of the DEA Registered location(s) as it appears on the registrant's DEA Registration Certificate (Form DEA-223). Inconsistency between the application and the registration certificate will result in approval delays or denial.

Section 3 – Applicant/Notary Signature (all fields required)
Field NameInformation Description
Applicant Signature, DateThe applicant must sign and date the application using blue or black ink IN THE PRESENCE of a certified notary public. The party signing this application must be the same party listed in Section 1 – Applicant Information (First Name/Last Name/MI).
Notary Signature, Date

Registrant and Coordinator Applicants - A CERTIFIED NOTARY PUBLIC must sign the Registrant List Addendum(s) attached to the Certificate application using blue or black ink.

Power of Attorney Applicants - The CSOS Coordinator must sign the Registrant List Addendum(s) attached to the Power of Attorney Certificate Application using blue or black ink.


Warning: When the applicant signs the application, he/she is stating that he/she has read, understood, and agreed to abide by the rules and regulations contained in the Controlled Substance Ordering System Subscriber Agreement and Certificate Policy. He/she is certifying that the information, statements and representations provided by him/her on the application are true and accurate to the best of his/her knowledge. He/She understands that presenting false information is a criminal offense and is punishable by law. Section 843(a)(4)(A) of Title 21, United States Code, states that any person who knowingly or intentionally furnishes false or fraudulent information in the application is subject to imprisonment for not more than four years, a fine of not more than $30,000.00 or both.

In accordance with the Paperwork Reduction Act of 1995, no person is required to respond to a collection of information unless it displays a valid OMB control number. The OMB control number for the collection of this information is 1117-0038. Public reporting burden for this collection of information is estimated to average 0.72 hour, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.

Please contact DEA Diversion E-Commerce Support for enrollment assistance.
Phone: 1-877-DEA-ECOM (1-877-332-3266)
E-mail: CSOSsupport@deaecom.gov
Section 1 - Applicant Information
Application Last Name

Application First Name

MI
Applicant SSN Number
   

Section 2 - DEA Registration List
DEA Registrant No. DEA Registrant Name

Would you like to updated the address:
Entered Address
Suggested Address