Applications and Forms

Radioactive Materials Licenses

Document Number Title
CI-40 General License Acknowledgement Self-Evaluation Form
RC 251-2 General License Acknowledgement of Devices Containing Radioactive Material (PDF, 1.3MB)
RC 252-1 Business Information Form - License (PDF, 256KB)
RC 252-2 Radioactive Material License (PDF, 66KB)
RC 252-4 Certificate of Disposition (PDF, 206KB)
313A(RSO) Radiation Safety Officer (and Associate Radiation Safety Officer)
313A(AUD) Authorized Users for (1)Uptake, Dilution, and Excretion Studies (2)Imaging and Localization Studies (3)Sealed Sources for Diagnosis
313A(AUT) Use of Unsealed Radioactive Material for which a Written Directive is Required (Including I-131)
313A(AMP) Authorized Medical Physicist or Ophthalmic Physicist
313A(ANP) Authorized Nuclear Pharmacist
313A(AUS) Manual Brachytherapy, Ophthalmic Use of Strontium-90, Remote Afterloaders, Teletherapy Units, or Gamma Stereotactic Radiosurgery Units
RC 257-1 Application for A Low Level Radioactive Waste Shipper Registration (PDF, 251KB)
RC 257-2 Application for Low Level Radioactive Waste Transporter Registration (PDF, 230KB)

Notice to Employees

Document Number Title
RC 203-1 Notice to Employees (PDF, 10KB)
RC 232-1 Notice to Employees (Dentists Only) (PDF, 9KB)
RC 233-2 Notice to Employees (Vets Only) (PDF, 64KB)

Licensing Reciprocity

Document Number Title
RC 252-3 Notice of Intent to Work in Texas Under Reciprocity (PDF, 306KB)
Please review the “Sensitive Information” notice on the form.
Fillable form version of the RC 252-3 (PDF, 320KB)
RC 252-5 RAM Reciprocity Application (PDF, 158KB)