DEA Form 41: How to Fill It Out (Filled-In Sample + PDF)

What is DEA Form 41?

DEA Form 41 is the Registrant Record of Controlled Substances Destroyed. Under DEA’s disposal rules (21 CFR 1317), controlled substances have to be destroyed to a non-retrievable state — permanently, so they can’t be reused — and Form 41 is the record of that destruction: what was destroyed, how much, how, when, where, and who witnessed it.

You need one whenever controlled substances are destroyed: expired or unwanted inventory, recalled product, and controlled substances collected through take-back. It covers Schedules I through V.

Who fills out DEA Form 41?

The registrant that actually destroys the drugs completes Form 41. When you send your controls to a DEA-registered company for destruction, that company completes Form 41 as the destroying registrant.

• Your side of the paperwork is the transfer record — a DEA Form 222 for Schedule I and II drugs, a transfer form for Schedules III–V — plus the Certificate of Destruction.

When you don’t need DEA Form 41

• Controls you send to a reverse distributor. You complete the transfer paperwork (Form 222 for Schedule I–II, an invoice or transfer form for III–V). The reverse distributor destroys the drugs and completes Form 41.
• Theft or loss. That’s DEA Form 106, not Form 41.

Filled-in DEA Form 41 sample

Section A — Registrant information

The destroying registrant’s registered name, DEA registration number, registered address, city, state and ZIP, plus a contact name and telephone number. Use the name and address exactly as they appear on the DEA registration.

Section B(1) — Inventory destroyed

One line per product. Each line records:

• National Drug Code (NDC) — or a description if the item has no NDC
• Batch number — where applicable
• Name of substance, strength and form — e.g. hydrocodone/APAP, 10/325 mg, tablet
• Package quantity — the count in a full package
• Number of full packages and the partial package count
• Total destroyed — the final quantity for that line

Section B(2) — Collected substances

Controlled substances collected through take-back (mail-back packages or sealed inner liners) aren’t itemized, because the sealed packages aren’t opened. Instead you record each package’s unique identification number, its size, and the quantity of packages or liners destroyed.

Section C — Method, date and place of destruction

How the substances were rendered non-retrievable (for example, incineration), the date of destruction, and the location or business name and address where it happened.

Section D — Witnesses

Two authorized employees sign by hand, with their printed names, declaring under penalty of perjury that they personally witnessed the destruction of everything listed in Section B.

Witness and recordkeeping rules

• Two witnesses for every destruction, signing by hand.
• Keep it at least two years — longer if your state Board of Pharmacy requires — and make it available for inspection.
• It isn’t mailed to DEA unless DEA asks for it. Form 41 stays with your controlled-substance records.
• Keep it with the related paperwork: the Form 222 or transfer form for anything you sent out, and the Certificate of Destruction.

Common DEA Form 41 mistakes

• Lines that don’t match inventory. Quantities on Form 41 must reconcile with your perpetual inventory and dispensing records.
• A blank method or date in Section C.
• One witness, or witnesses added later. Both witness the destruction itself.
• Missing NDCs on lines where the product has one.
• Flushing or drain disposal. It doesn’t meet the non-retrievable standard, so a Form 41 can’t cover it.
• No paper trail for drugs sent out — a missing Form 222 for Schedule II transfers is a common inspection finding.

Where to get the DEA Form 41 PDF

• Official form: DEA Form 41 (PDF) from the DEA Diversion Control Division, with instructions on DEA’s Form 41 page.

Use DEA’s current version. Copies on form-filler sites can be out of date, and some still carry the pre-2014 title. When you send controls to a DEA-registered reverse distributor, it completes Form 41 for you — see controlled substance destruction.

Form 41 vs. Form 222 vs. Form 106

Old vs. current DEA Form 41

Before DEA’s 2014 disposal rule (21 CFR 1317), Form 41 was titled Registrants Inventory of Drugs Surrendered, and registrants sent it to DEA to ask permission to destroy controlled substances. The rule renamed it the Registrant Record of Controlled Substances Destroyed and made it a record you keep on file. That’s why older guides, and some university and state pages, still say to mail Form 41 to DEA.