Follow the steps to complete your application effectively.

1. Click ‘Get Form’ button to obtain the form and open it in your preferred document editor.
2. In item 1, specify the type of application by checking the appropriate box for 'New License', 'Renewal', or 'Amendment'.
3. Fill in item 2 with the applicant’s name and mailing address, as well as the radioactive material license number if applicable.
4. In item 3, provide the contact information of the person responsible for the application, including phone numbers, fax numbers, and email addresses.
5. Complete item 4 with the address where radioactive material will be used. Indicate if there are any temporary job sites.
6. For item 5a, list the names of individuals authorized to use radioactive material and attach evidence of their training and experience.
7. In item 5b, enter the name of the teletherapy physicist and attach evidence of their training and experience if applicable.
8. For item 6, enter the name and contact information for the radiation safety officer, attaching proof of their training and experience.
9. In item 7a, check all applicable radioactive materials and indicate their form, maximum activity, and possession limits.
10. Complete item 7b for any radioactive materials not listed in item 7a, specifying radionuclides and material uses.
11. In item 8, indicate the duties and responsibilities of the radiation safety committee if applicable.
12. Attach the required documentation for item 9, including a completed Exhibit C or equivalent.
13. For item 10a, select and confirm the calibration methodologies for dose calibrators.
14. Complete item 10b with your selection and confirm the calibration procedures for monitoring instruments.
15. Attach diagrams and descriptions required in item 11 related to the facilities and equipment.
16. Provide a description of the training program for item 12.
17. In item 13, attach the procedure for ordering and receiving radioactive materials.
18. Complete items 14 to 20 with the procedures indicated in the respective appendices.
19. In item 21, specify if applicable procedures for the use of sealed sources for brachytherapy are required.
20. For item 23, detail monitoring types and frequencies.
21. Fill out item 24 regarding license fees without submitting payment.
22. Confirm the financial assurance requirements in item 25 and check the appropriate boxes for new applicants or renewals.
23. In item 26, carefully complete the certification section, ensuring all information is accurate and attach your signature.
24. Finally, review the entire form for completeness, save your changes, and prepare to download, print, or share the completed form as needed.

Start your application for a medical radioactive material license by filling out the Iema Flm001m A form online today.