Get Facility Registration Number - Mde State Md

This guide provides step-by-step instructions on how to accurately fill out the Facility Registration Number - Mde State Md online. It aims to assist users regardless of their experience level, ensuring a smooth application process.

Follow the steps to complete your registration form effectively.

1. Press the ‘Get Form’ button to access the form and open it in your preferred document editor.
2. Indicate the date of application in the provided field.
3. Select the type of application by checking the relevant box: Initial, Renewal, or Amendment. If applicable, provide your current registration number.
4. Fill in the location details of the particle accelerator or where it is stored, including the registrant's name, address, phone number, city, state, and zip code.
5. Specify whether the registrant is an individual, partnership, corporation, unincorporated association, or other. Fill in the corresponding address, city, state, and zip code for this section.
6. Provide your Federal Tax Identification Number in the provided field.
7. Complete the section regarding particle accelerator information, including the type of accelerator, peak kV or MeV, year and model, type of radiation, maximum intensity, and purpose of use.
8. Attach the required documents as listed, such as a description of the radiation safety program, architectural plans, and any other necessary supporting information.
9. Indicate whether radioactive materials are produced incidentally by the operation of the machine by selecting 'yes' or 'no'.
10. Ensure the signatures of the Chief Executive Officer and Radiation Safety Officer are completed, including their names, titles, signatures, and dates.
11. Once all information is accurately filled, you can save changes, download, print, or share the completed form as needed.

Start filling out your Facility Registration Number - Mde State Md form online today for a seamless application process.