Forms

Immigration

Declaration of U.S. Citizenship or Lawful Presence of an Alien - Declaration Form Required for all Individuals or Sole Proprietorships Applying for a License from the Office of Radiation Control

Declaration of Business Ownership Structure - Declaration Form that Indicates an Applicant's Business Structure (Required if the Type of Business Entity is Not Clearly Indicated on the Application)

Radioactive Material

Form RM - Application for a Radioactive Materials License

Form RM-HU (AUD) - Preceptor Form for Physicians Wishing to be Authorized for Use of Unsealed Radioactive Materials and Diagnostic Sealed Sources for which a Written Directive is Not Required

Form RM-HU (AUT) - Preceptor Form for Physicians Wishing to be Authorized for Use of Unsealed Radioactive Materials for which a Written Directive is Required

Form RM-HU (AUS) - Preceptor Form for Physicians Wishing to be Authorized for Use of Sealed Source Radioactive Materials for which a Written Directive is Required

Form RM-HU (RSO) - Preceptor Form for Individuals Wishing to be Authorized for Medical Use Radiation Safety Officer

Form RM-HU (AMP) - Preceptor Form for Individuals Wishing to be Authorized as Therapeutic Medical Physicists

Form RM-HU (ANP) - Preceptor Form for Individuals Wishing to be Authorized as Nuclear Pharmacists

Form RH 313R - Radioactive Material Application Addendum for Industrial Radiography (Corporate Structure)

Form SM - Application for a Source Material License

Form DRM - Disposition of Radioactive Material (Documentation of Proper Transfer or Disposal)

Form GL - Registration of General License Devices

Form RR - Request to Work In Alabama Under Reciprocity

Fee Schedule - Fee Schedule for Radioactive Material Licensees effective August 29, 2017

Form S - Medical Misadministration Report

Form Small Entity - Certification of Small Entity Status for Annual Fees

Form Y - Cumulative Occupational Exposure History

Form Z - Occupational Exposure Record for a Monitoring Period

Machine Registrations

View App - Application for Registration for Sources of Radiation (For Medical X-Ray Tubes with Energies <0.9 MeV)

Form PA-2 - Application for Notice of Registration (To Register Accelerators and Cyclotrons with Energies >0.9 MeV)

Form NMX - Application for Non-Medical X-Ray Registration (Industrial X-Ray Units)

View Form - Registration of Radiation Services For Medical X-Ray Equipment

View Form - Registration of Radiation Services For Non-Medical X-Ray Equipment

Form PA-NRS - Application to Register as a Servicer of Particle Accelerators (For Companies)

Form PA-NRS-1 - Application to Register as a Servicer of Particle Accelerators (Supplemental Form for Individuals)

View Form - Radiation Safety Training Certificate for Servicers of X-Ray Equipment

View Form - Request for Handheld Dental X-Ray Exemption

View Form - X-Ray Screening Request

View Form - Bone Densitometer X-Ray Waiver Request

Machine Assembly

View Form - Report of Assembly of Non-Certified X-Ray Systems (i.e., those not reported on Federal Form FD2579)

Industrial Radiography Certification

View Schedule - 2017 Exam Schedule and General Information - Radiographer Examination Schedule

View App - Application for Industrial Radiographer Examination - Radiographer Cert Application

View Form - Request for Disability Accommodation for Industrial Radiography Examination - Radiography Disability

View Form - Procedure to Replace a Lost or Misplaced Radiographer Certification ID Card - Radiographer Card Replace

View Form - Procedure to Upgrade Radiographer Certification ID Card from Single Purpose (Example: X-Ray Only) to Dual Purpose (Both X-Ray and RAM) - Radiographer Second Card

View Form - Industrial Radiographer On-The-Job Training (OJT) Form - Radiographer OJT Card

View Form - Industrial Radiographer Qualification Form - Radiographer Qualifications

DOT Exemptions

View Form - Instructions for radiation found in scrap metal

View Form - Exemption Form scrap metal

View Form - Marking scrap metal

View Form - Instructions for radiation found in waste

View Form - Exemption Form waste

View Form - Marking waste

General

View Form - Radiological Emergency Assistance Form

Form X - Notice to Employees

Form 100 - Notice of Where Copies of Documents May be Found


Page last updated: August 11, 2017