Get Radiation Machine Facility Registration Kansas Form

Filling out the Radiation Machine Facility Registration Kansas Form online can seem daunting, but with clear guidance, you can complete it efficiently. This guide will walk you through each step of the process, ensuring you understand every section and field.

Follow the steps to complete your registration accurately.

1. Click ‘Get Form’ button to obtain the Radiation Machine Facility Registration Kansas Form and open it in your preferred editor.
2. In the Registrant Information section, provide the facility name, physical address where the radiation machine is located, and city, state, and zip code. If a different mailing address is preferred, indicate this by checking the box labeled 'same as above.'
3. Enter the telephone and fax numbers where your facility can be reached. Include a contact person’s name for correspondence.
4. Fill in the Federal Employer Identification Number (FEIN) of your facility to help verify your registration.
5. In the Radiation Machine Information section, indicate the type of machine you are registering by using the appropriate code from the provided list. Ensure you accurately reflect the machine's make, model, and serial number of the x-ray tube or control.
6. Specify the room number or other location within the facility where the radiation machine is housed. If additional space is needed, include separate pages.
7. Certify the information provided by signing and printing your name, along with the date of submission. Ensure that the signature is from a responsible party such as the company president or a licensed practitioner.
8. Finally, prepare the form for submission by attaching the required payment of the registration or renewal fee, which is $120. Mail the completed form to the specified address or send it via fax, noting that the original must be mailed for full processing.

Complete your Radiation Machine Facility Registration Kansas Form online today to ensure compliance and proper registration.