Follow the steps to successfully complete the Zz113 120 online.

1. Click 'Get Form' button to access the Zz113 120 form and open it for editing.
2. Provide the legal name of the facility as filed with the Texas Secretary of State Office and include a Doing Business As name if applicable.
3. Enter the mailing address, including street address, city, state, and zip code.
4. Input the physical location of the facility, including street address, city, state, and zip code, along with the county.
5. Fill in the facility site phone number and site fax number.
6. Designate a radiation safety officer (RSO) and attach the required qualifications as per 25 TAC § 289.226. Provide their telephone number and email address.
7. Check all applicable types of action as listed on the form, such as new registration or renewal of registration.
8. Indicate the total number of x-ray machines used in each category, based on your facility's physical location.
9. If mobile services are used, indicate the name and registration number of the provider of equipment.
10. Affirm the licensed practitioner's association with the applicant and signature along with their Texas License Board number.
11. The radiation safety officer must affirm their duties by providing their name, Texas License Board number, signature, and date.
12. Certify the administration of radiation under the supervision of an appropriately licensed practitioner and ensure the applicant's and owner's or partner's signatures and dates are included.
13. Once the form is fully completed, save your changes. You can then download, print, or share the completed Zz113 120 form as needed.

Begin completing the Zz113 120 document online today to ensure your application is submitted accurately.