The New Jersey Application Registration form is vital for individuals or firms in New Jersey that handle controlled dangerous substances (C.D.S.), including manufacturing, prescribing, distributing, dispensing, or conducting research or analysis with these substances. Issued by the New Jersey Office of the Attorney General Division of Consumer Affairs Drug Control Unit, it enforces a strict requirement for a $40.00 registration process, crucial for maintaining the integrity and regulation of controlled substances within the state. Understanding the specifics of this registration, including who needs it, the costs involved, and how to submit the application, can guide professionals through the necessary legal compliance steps.
The NJ Application Registration form serves as a critical gateway for professionals and entities in New Jersey dealing with controlled dangerous substances (C.D.S.). Governed by the New Jersey Office of the Attorney General, Division of Consumer Affairs, and the Drug Control Unit, the form mandates registration for anyone engaged in manufacturing, prescribing, distributing, dispensing, or researching controlled substances within the state's borders. A non-refundable fee of $40.00, payable to the State of New Jersey, is required alongside the application, which is processed within 4-6 weeks. Applicants must provide a broad array of information, including their professional license and specific details on the location where C.D.S. will be handled. It is notable that both federal DEA registration and New Jersey C.D.S. registration are necessary for legal operation, subject to rigorous checks and potential inspections as per state law. This form is an essential step for professionals like doctors, dentists, and pharmacists among others, ensuring compliance with New Jersey's Controlled Dangerous Substances Act (N.J.S.A. 24:21-1 et seq.), highlighting the state's commitment to safely managing controlled substances. The application also includes a section for certifying the completeness and accuracy of the provided information, underlining the serious legal implications of falsification.
New Jersey Office of the Attorney General
Division of Consumer Affairs
Drug Control Unit
124 Halsey Street, 6th Floor, P.O. Box 45045, Newark, NJ 07101
(973) 504-6351
Controlled Dangerous Substance Registration
Instruction sheet
Enclosed is a Controlled Dangerous Substance (C.D.S.) application, which you are required to submit pursuant to N.J.S.A. 24:21-1 et seq. Registration is required for every person who, or firm that, manufactures, prescribes, distributes, dispenses or conducts research or analysis utilizing controlled dangerous substances.
A New Jersey C.D.S. registration is issued only for a New Jersey location. Be sure to include a $40.00 check or money order, payable to “State of New Jersey.” It will take 4-6 weeks to process this application. Your C.D.S. registration will be mailed to the mailing address on file with your professional licensing board.
Please note:
1.If you have a current D.E.A. number in another state and plan to discontinue practice in that state, you may transfer that D.E.A. number to New Jersey by providing the following to the Drug Enforcement Administration, 80 Mulberry Street, Newark, New Jersey 07102, (888-356-1071) www.deadiversion.usdoj.gov:
a.a copy of your New Jersey professional license or a verification letter from the licensing board;
b.a copy of your New Jersey C.D.S. registration or a verification letter;
c.a copy of your out-of-state D.E.A. registration; and
d.a letter requesting an address change to the same address that is on your New Jersey C.D.S. registration.
A D.E.A. number is only valid in the state listed on the certificate.
2.If you plan to practice in both New Jersey and the state(s) where you currently hold a D.E.A. registration(s), you must also obtain a D.E.A. registration for New Jersey. Please contact the D.E.A. at the address indicated above and complete the New Jersey application.
3.In order to complete the attached application, please note:
a.A dispenser/prescriber/ practitioner includes medical doctors, doctors of osteopathy, dentists, optometrists, veterinarians, and podiatrists. A mid-level dispenser/prescriber/practitioner includes physician assistants, advanced practice nurses and certified nurse midwives. Pharmacies must complete a separate application.
b.Every person or firm handling controlled dangerous substances in New Jersey is required to have both a state and federal registration for that purpose. Federal facilities do not require registration.
c.The address supplied must be current and an actual location where controlled dangerous substances will be stored, prescribed, dispensed, etc. The address cannot be solely a post office box.
d.Dentists and optometrists may only register at the address for which they hold a current registration issued by their board and at which the C.D.S. registration is required pursuant to 3(c) above.
e.Individual practitioner applicants (medical doctors, dentists, veterinarians, etc.) must use their own name, not professional association/corporation or partnership information.
f.Pharmacies are required to use their common trading name (e.g. David Pharmacy), not a business or corporate name.
g.Dispensers/Prescribers must have an active and current New Jersey professional license number. Please write in your New Jersey professional license number in “Section B” of the application.
•Advanced Practice Nurses may prescribe controlled dangerous substances, but may not purchase or maintain any stock supplies of any C.D.S. medication.
•Optometrists are authorized to prescribe/dispense only Schedule III, IV and V controlled substances and must have an O.M. number registered with their board.
4.If more space is required for your response to any question on the application, please submit a separate sheet of paper identifying the section(s) to which you are responding.
If we can be of further assistance, please call 973-504-6351.
Rev. 3/19
Initial Application for Registration
for Dispenser – Pharmacy
P.O. Box 45045
New Jersey Controlled Dangerous Substances Act
Newark, NJ 07101
N.J.S.A. 24:21-1 et seq.
Please type or print clearly.
Section A:
All of the items in this section must be completed.
Section B:
Pharmacy Licensure Information
1. Provide the applicant’s name and the place of business to be registered (do
Pharmacy permit number _____________________________________
not use solely a P.O. box). Registration will be provided for New Jersey
locations only. If the registration is for a University of Medicine and
Dentistry of New Jersey facility, include the department, room number,
designation, e.g. MEB, MSB, etc. The address of record must be your
Section C:
Business Information
pharmacy/facility location.
1. List the name, address and telephone number of the person who has
________________________________________________________
administrative or managerial responsibility for the registered location.
Pharmacy permit trade name
Last name
First name
MI
C.D.S. – Responsible Individual
Department
Room number
Street address
2. List the name, address and telephone number of the registered agent (if a
________________________
New Jersey
__________________
corporation) or the name and address of the New Jersey resident upon whom
City
ZIP code
process may be served (if a nonresident proprietor or partner).
____________________________
__________________________
Home telephone number (include area code)
Business telephone number (include area code)
Note: Please note that the above-registered address is subject to inspection pursuant to N.J.S.A. 24:21-31 & 32.
2. Registration requested as: Dispenser ($40)
Make the check or money order payable to: State of New Jersey
3. Registration requested in the following Schedule(s):
Schedule
II
III
IV
V
Section D: Certification
4. (a) Has any restriction been imposed which would affect your privilege
to hold a controlled dangerous substances (C.D.S.) registration for
Schedule II, III, IV or V substances in New Jersey, any other state,
I, _____________________________________ being duly sworn, depose
the District of Columbia or in any other jurisdiction?*
and say under penalty of false statement, that I am the person described and
Yes
No
identified intis application; that the information given in this application and
(b) Have you been arrested, indicted or convicted of a crime in
all submitted materials contain no willful misrepresentations and that the
connection with controlled substances under federal law or the laws
of New Jersey, any other state, the District of Columbia or any other
information is true and complete. I understand that should an investigation
jurisdiction?*
at any time disclose otherwise, my application may be rejected, and I may
(c) Have you ever surrendered a controlled drug registration or had a
face legal sanctions if I am already registered. I understand that in signing
controlled drug registration revoked, suspended or denied in New
this application for registration, I am consenting to any reasonable inquiry
Jersey, any other state, the District of Columbia or in any other
that may be necessary to verity the information that I have provided on this
form or may provide in conjunction with this application.
(d) If the applicant is a corporation, association, or partnership: has any
officer, partner, stockholder holding 10% or more of the outstanding shares
or employee who has access to controlled dangerous substances been
convicted of a crime in connection with controlled substances under
federal law or the laws of New Jersey, any other state, the District of
____________________________________________
Columbia or any other jurisdiction?*
(e) If the applicant is a corporation, association, or partnership: has any
Applicant's signature
officer, partner, stockholder holding 10% or more of the outstanding
shares or employee who has access to controlled dangerous substances
surrendered a controlled drug registration, had a controlled drug
registration suspended, revoked, or denied, or owned or worked
Date
for an entity which has surrendered or had revoked, suspended, or
denied a controlled drug registration under federal law or the laws
* If "Yes," attach a letter setting forth the circumstances of such action.
For State USe only
C.D.S. number________________________ Effective date ___________________________ Expiration date ______________________
Retain the last copy for your records. Mail the remaining copies with your fee to the above address.
DDC-25 Revised 3/19
Filling out the New Jersey Application Registration form for Controlled Dangerous Substances (C.D.S.) is a step toward compliance for those in New Jersey who handle such substances. This includes manufacturing, prescribing, distributing, dispensing, or conducting research with controlled substances. Whether you are a medical professional, a research facility, or a pharmacy, this registration is crucial. The process might seem daunting, but with the following instructions, it can be completed with ease. Remember to prepare a $40.00 check or money order payable to “State of New Jersey” and allow 4-6 weeks for processing. Your registration will then be mailed to the address on file with your professional licensing board.
After submission, patience is key as processing can take 4-6 weeks. Holding a current C.D.S. registration not only complies with New Jersey state law but also ensures the safety and well-being of those who come into contact with controlled dangerous substances. If there are any questions or if further assistance is needed, contacting the provided phone number is recommended.
The New Jersey Controlled Dangerous Substance (C.D.S.) application is required for individuals or entities such as medical doctors, pharmacies, and researchers involved in manufacturing, prescribing, distributing, dispensing, or conducting research with controlled dangerous substances. Its purpose is to gain authorization under New Jersey law, specifically N.J.S.A. 24:21-1 et seq, for activities involving such substances within the state.
Every individual or firm that handles controlled dangerous substances within New Jersey must obtain both state and federal registrations. This includes, but is not limited to, medical doctors, doctors of osteopathy, dentists, optometrists, veterinarians, podiatrists, physician assistants, advanced practice nurses, certified nurse midwives, and pharmacies. Federal facilities are exempt from this requirement.
If you have a current D.E.A. number in another state and wish to discontinue your practice there, you can transfer your D.E.A. number to New Jersey. This process involves providing the Drug Enforcement Administration (D.E.A.) with a copy of your New Jersey professional license or a verification letter from the licensing board, a copy of your New Jersey C.D.S. registration or a verification letter, a copy of your out-of-state D.E.A. registration, and a letter requesting an address change to the same address on your New Jersey C.D.S. registration.
The application for C.D.S. registration requires a $40.00 fee, payable to “State of New Jersey.” The processing time for this application is approximately 4-6 weeks. The registration will be mailed to the mailing address on file with your professional licensing board upon completion.
The application form requires detailed information including:
If you plan to practice in both New Jersey and another state where you currently hold a D.E.A. registration, you must obtain a separate D.E.A. registration for New Jersey. Contact the D.E.A. at the provided address and complete the New Jersey application to facilitate this requirement.
Yes, certain restrictions apply:
Filling out the New Jersey Application Registration form for Controlled Dangerous Substances (C.D.S.) requires careful attention to detail to avoid common mistakes. Here is an expanded list of mistakes that people often make on this application:
Not providing a physical location: Applicants sometimes list a P.O. Box as their address. However, the form explicitly requires the address to be an actual location where the controlled substances will be stored, prescribed, dispensed, etc. This is essential since a P.O. Box does not provide an accurate location for regulatory inspections.
Incorrect licensure information: It's crucial to include the correct New Jersey professional license number in Section B. This oversight can complicate the verification process, delaying or even jeopardizing the application's approval.
Application not personalized: Individuals must apply under their own names, particularly when the applicant is an individual practitioner like a medical doctor or dentist. Using a professional association, corporation, or partnership name instead of the individual’s name is a common error.
Not specifying registration for the correct schedules: The form requires applicants to indicate the schedules of controlled dangerous substances they request registration for. Failing to correctly identify the needed schedules can limit the practitioner’s ability to prescribe, dispense, or handle the necessary substances.
Failure to include the fee: A $40.00 fee, payable to "State of New Jersey", is required with the application submission. Sometimes applicants forget to include the check or money order, resulting in application processing delays.
Omitting required signatures and certifications: Section D demands the applicant’s signature under penalty of false statement. Missing signatures or incomplete certifications can render the application invalid.
Lack of supplementary documents for a D.E.A. number transfer: When transferring a D.E.A. number from another state, applicants must provide additional documents, including a copy of the New Jersey professional license, a verification letter, and the out-of-state D.E.A. registration. Failing to attach these documents can stall the transfer process.
Addressing these common mistakes can streamline the application process, helping to ensure compliance with New Jersey's Controlled Dangerous Substances Act and facilitating the lawful handling of controlled substances within the state.
When applying for a Controlled Dangerous Substance (C.D.S.) registration in New Jersey, there are several other forms and documents that are often needed to support your application. These materials serve various purposes, from establishing legal eligibility to ensuring compliance with both state and federal regulations. Understanding what each document entails will streamline the application process, ensuring that all necessary information is accurately presented and any potential delays are minimized.
Successfully navigating the application process for a Controlled Dangerous Substance registration in New Jersey requires attention to detail and a thorough understanding of both state and federal requirements. By gathering and preparing these essential documents in advance, applicants can ensure a smoother application process, contributing to the ultimate goal of providing safe and responsible healthcare services.
The New Jersey Application Registration Form for Controlled Dangerous Substances (C.D.S.) shares similarities with the Drug Enforcement Administration (DEA) Registration Application. Both forms are utilized by healthcare professionals to obtain the legal authorization necessary to handle controlled substances. Just as the New Jersey form requires personal, professional, and facility information, the DEA application also gathers similar data to ensure the applicant meets federal criteria for managing these drugs. The primary aim of both is to prevent the diversion of controlled substances by ensuring that only qualified and licensed individuals have access to them.
Another document resembling the New Jersey C.D.S. Application is the Pharmacy Permit Application, which pharmacies must file in many states, including New Jersey, to legally operate. This document, similar to the C.D.S. registration, asks for detailed information about the pharmacy's location, ownership, and personnel responsible for the controlled substances. Both applications serve as a means to regulate and monitor entities that dispense medications, ensuring compliance with state and federal laws.
The Healthcare Facility Licensing Application parallels the New Jersey C.D.S. Application in that healthcare facilities must provide extensive information to obtain or renew their license, including details about services offered, types of patients treated, and the qualifications of their staff. Similar to the requirements for the C.D.S. application, facilities that handle controlled substances must also demonstrate compliance with specific regulatory standards, highlighting the oversight into their practices.
Likewise, the Professional Licensing Application for medical doctors, dentists, veterinarians, and other health practitioners necessitates comprehensive personal and professional information, akin to the C.D.S. application. Both forms ensure that only qualified individuals can either practice their profession or manage controlled substances, thus maintaining public safety and professional integrity.
The Corporation Business Registration Application is akin to aspects of the New Jersey C.D.S. Application when a corporation or partnership applies for a C.D.S. Registration. Both require details about the business, including its legal structure, key personnel, and operational address. This comparison underscores the regulatory emphasis on understanding the ownership and management of entities engaged in controlled substances-related activities.
The Clinical Laboratory Improvement Amendments (CLIA) Application is another analogous document, especially for locations that conduct research or analysis with controlled substances, as mentioned in the C.D.S. application. Both applications require detailed information about the facility, the qualifications of individuals handling substances or specimens, and compliance with specific operational standards, ensuring that only competent entities perform high-stakes work with public health implications.
Similarly, the Biohazardous Waste Permit Application shares common ground with the C.D.S. application, particularly for facilities that dispose of or manage waste produced from drugs or pharmaceuticals. Both forms necessitate detailed operational descriptions and adhere to stringent regulatory standards to protect public health and safety by mitigating risks associated with handling potentially dangerous substances.
The Controlled Substance Researcher Registration Form, required at the federal level and sometimes at the state level for researchers handling controlled substances, parallels the New Jersey form by demanding specific information related to the research project, substances involved, and security measures. Like the New Jersey C.D.S. application, this form helps to ensure that research involving controlled substances is conducted responsibly and ethically.
Lastly, the Medical Marijuana Dispensary Application in states where medical cannabis is legal resembles the New Jersey C.D.S. registration process. Both applications require applicants to provide detailed information about their facilities, security measures, and staff qualifications to ensure that only authorized entities can dispense these substances. The oversight underscores the regulatory bodies' focus on controlling access to substances that have potential for misuse.
When completing the NJ Application Registration form for Controlled Dangerous Substances (C.D.S.), it is crucial to follow specific guidelines. These actions will ensure accurate completion and compliance with New Jersey regulations.
By paying attention to these do's and don'ts, you can ensure a smoother registration process for handling controlled dangerous substances in New Jersey, thereby avoiding common pitfalls and mistakes that could delay approval.
There are several misconceptions regarding the New Jersey Application Registration form for Controlled Dangerous Substances (C.D.S.). Understanding these can help clarify the registration process for individuals and firms dealing with controlled substances in New Jersey.
It's only for physicians: The belief that the C.D.S. registration is exclusively for physicians is incorrect. The application encompasses a wider range of professionals, including but not limited to dentists, veterinarians, optometrists, and even mid-level practitioners such as physician assistants and advanced practice nurses. Pharmacies are also required to apply, using their common trading name.
One registration covers all states: Another common misunderstanding is that obtaining a C.D.S. registration in New Jersey will cover activities in other states as well. However, the registration issued by New Jersey is only valid within the state. Professionals must obtain separate registrations for each state where they intend to handle controlled dangerous substances.
No need for separate DEA registration if holding C.D.S. registration: Some might think that if they hold a New Jersey C.D.S. registration, they do not need a Drug Enforcement Administration (DEA) registration. This is not true. To handle controlled substances, both a state C.D.S. registration and a DEA registration are required for compliance with federal and state laws.
Only dispensers need to apply: The misconception that only those who dispense medications need to apply for a C.D.S. registration overlooks several other categories of professionals and establishments that require registration. Those involved in prescribing, manufacturing, distributing, conducting research, or analysis utilizing controlled dangerous substances in New Jersey must register.
Personal and business information is interchangeable: Some applicants may believe that they can use their business or corporation name interchangeably with their personal name on the application. However, individual practitioners must use their own name, not their professional association, corporation, or partnership information on the form. Conversely, pharmacies are required to use their trading name.
Clarifying these misconceptions can help ensure that the registration process is completed accurately and in compliance with New Jersey regulations. Every person or firm interacting with controlled dangerous substances within the state must adhere strictly to these guidelines to ensure legal operation and management of these substances.
Filling out the New Jersey Controlled Dangerous Substance (C.D.S.) Application Registration form is an essential step for professionals and firms in New Jersey dealing with controlled substances. Here are key takeaways to assist you in completing and using this form effectively:
Accurate and thorough completion of the C.D.S. Application Registration form ensures compliance with New Jersey regulations concerning controlled substances, facilitating a smooth process to secure or transfer your registration.
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