License forms and instructions
Forms and guidance for preparing a license application for specifically licensed materials or devices. Please review the appropriate application and instructions along with the applicable regulation parts and sections to ensure that all of the necessary requirements.
Forms for medical use applicants and licensees
Application for a radioactive materials license authorizing the medical use of radioactive materials.
- Instructions for the preparation of an application for a radioactive materials license for the medical use of radioactive materials.
- Authorized user training, experience, and preceptor attestation for diagnostic uses of radioactive materials.
- Authorized user training, experience, and preceptor attestation for unsealed therapeutic uses of radioactive materials (7.36 uses).
- Authorized user training, experience, and preceptor attestation for sealed therapeutic uses of radioactive materials (7.42 and 7.48 uses).
- Authorized medical physicist or ophthalmic physicist training, experience, and preceptor attestation.
- Medical radiation safety officer or associate radiation safety officer training, experience, and preceptor attestation.
- Associate Radiation safety Officer model appointment form.
- Authorized nuclear pharmacist training, experience, and preceptor attestation.
- Instructions for Patients Treated With Radiopharmaceuticals or Implants.
Forms for non-medical use applicants and licensees
- Portable nuclear gauge license application.
- Annual program audit form for portable gauge users.
- Portable nuclear gauge public dose calculations.
- OR-RH 12-30 application for the use of radioactive materials for industrial radiographic operations.
- OR-RH 12-3.N application for persons providing services for other licensees.
- Application for a radioactive materials license - generic.
Other forms applicable to most specific licensees
- Application for a transfer or change of control for a radioactive materials license.
- OR-RH 23 Request for Termination of a Radioactive Materials License.
- RCD Form 62 certification of small entity status for purposes of annual fees.
Forms for Department of Transportation special permits or provisional licenses
These forms may be needed following detection of radioactive material at a recycling facility, landfill, or other location.
- DOT-SP 10656 shipment approval form
- Downloaded blank DOT-SP 10656 shipment approval form from the Conference of Radiation Control Program Directors Transportation, complete and submit by email to cdphe.hmdSpecialPermit@state.co.us.
- OR-RH-12.PRV application for a provisional license authorizing temporary possession of radioactive material pending disposal.
- OR-RH 15 notice to employees form-legal size.
- Standards for protection against radiation, notices, instructions and reports to workers, inspections, employee protection.
- OR-RH 16 Cumulative Occupational Exposure History.
- R-RH 17 Occupational Exposure Record for a Monitoring Period.
- Licensee certification of reviewing official example form.
- National Source Tracking System: NRC Form 748.
Most forms above are in pdf form, but have fillable fields. Contact the radioactive materials unit at firstname.lastname@example.org if you need an MS Word version of a form.