Applications and Forms

Radioactive Materials Licenses

Document NumberTitle
CI-40General License Acknowledgement Self-Evaluation Form
RC 251-2General License Acknowledgement of Devices Containing Radioactive Material (PDF, 1.3MB)
RC 252-1Business Information Form - License (PDF, 256KB)
RC 252-2Radioactive Material License (PDF, 66KB)
RC 252-4Certificate 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
 Xenon-133 Worksheet
 Y-90 Microspheres Documentation of Training - Experience- Attestation
RC 257-1Application for A Low Level Radioactive Waste Shipper Registration (PDF, 251KB)
RC 257-2Application for Low Level Radioactive Waste Transporter Registration (PDF, 230KB

 

 

 


Notice to Employees

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

Licensing Reciprocity

Document NumberTitle
RC 252-3Notice 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 252-5RAM Reciprocity Application (PDF, 158KB)