Maryland Controlled Dangerous Substances Researcher Questionnaire

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STATE OF MARYLAND
DHMH
Maryland Department of Health and Mental Hygiene
201 W. Preston Street • Baltimore, Maryland 21201
Martin O’Malley, Governor – Anthony G. Brown, Lt. Governor – John M. Colmers, Secretary
Division of Drug Control
4201 Patterson Avenue, Baltimore, MD 21215
410-764-2890, Fax 410-358-1793
Controlled Dangerous Substances (CDS)
Researcher Questionnaire
The highlighted text below is an EXAMPLE of what can be written, not a template.
The Fee is $120 for 2 years
Applicant Name ______________________________________________________
Facility Name ________________________________________________________
Address _____________________________________________________________
Telephone ______________________________ Fax. _________________________
Facility Maryland CDS Registration Number __PENDING___________ Exp. Date__________
Facility DEA Registration Number __PENDING___________________ Exp. Date__________
M-F ______ Sat. _______ Sun. ______ Hol. _______
(Hours that your lab is open e.g. M-F 8a-5p. Closed Sat/Sun/Holidays)
1. Brief description of the research/testing that will be conducted and list of controlled dangerous substances
("CDS") that will be used to conduct research/testing and approximate quantities per year.
Anesthetize/sedate animals for various research procedures and provide analgesia. You don’t need to describe your
specific research unless the controlled drugs are used as part of the research and not just for sedation/analgesia.
List drugs you will use and approximate bottle numbers
2. Who is the primary responsible person that supervises use of controlled substances at the facility?
The "Responsible Person" must be a principal investigator or have a faculty-rank appointment (i.e., faculty or
administrative professional). This person is ultimately responsible for obtaining approval to use a controlled substance,
and is responsible for the safe use, secure storage, and record keeping requirements of that controlled substance. The
Responsible Person certifies that the legally required records of receipts and disbursements of the controlled substances
listed on this application will be maintained for inspection, and that drug security measures will meet those required by
federal and state law.
3. Who are "individuals with access"?
Individuals with access are defined as persons that will handle the controlled substances, and all persons having access
to the locked storage unit containing those substances.
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