Drug Enforcement Administration
Sterling Park Technology Center / CSOS
8701 Morrissette Drive
Springfield, VA 22152
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. |
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). |
Field Name | Information Description |
Notary Acknowledgement | Enter the last name of the Registrant applicant. |
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 Name | Information Description |
Applicant Last Name | Enter the last name of the applicant. |
Applicant First Name | Enter the first name of the 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. |
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. |
Field Name | Information Description |
DEA Registration Num | Enter 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 Name | Enter 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. |
Field Name | Information Description |
Applicant Signature, Date | The 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.