4. Send the completed form to Indiana State Department of Health ATTN Cashier s Office 2 N. Meridian St. Indianapolis Indiana 46204 5. Nrsb.org or the National Radon Proficiency Program www. radongas. org for details. Also if applying for Primary Radon Tester or Radon Laboratory Tester enclose a copy of your Device Performance Test Report Listing Letter. Radongas. org for details. Also if you are applying for Radon Laboratory Tester or Primary Tester enclose your Device Performance Test Report Listing Letter. TYPE OF LICENSE DESIRED Check all that apply Radon Laboratory Tester Fee 100. 00 Secondary Radon Tester Fee 100. Reset Form APPLICATION FOR RADON TESTER / MITIGATOR LICENSE State Form 45703 R5 / 12-14 Approved by State Board of Accounts 2014 INDIANA STATE DEPARTMENT OF HEALTH INSTRUCTIONS 1. This is the radon certification application necessary to satisfy the requirements of 410 IAC 5. 1-1-22. 1-1-24 and 5. 1-1-26. NATIONAL RADON PROFICIENCY PROGRAM NRPP INFORMATION COMPLETE ALL T....

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How to fill out the IN State Form 45703 online

The IN State Form 45703 is the radon tester and mitigator certification application required by the Indiana State Department of Health. Completing this form accurately is essential for obtaining your license to test, analyze, or mitigate radon-222 in Indiana. This guide will provide you with clear, step-by-step instructions to help you navigate the process of filling out the form online.

Follow the steps to successfully complete your application.

  1. Click the ‘Get Form’ button to access the application form. This will open the form in an online editor, allowing you to begin filling it out.
  2. In the 'Type of License Desired' section, check all boxes that apply to your licensing needs, including options such as Radon Laboratory Tester, Secondary Radon Tester, Primary Radon Tester, and Radon Mitigator, noting the corresponding fees.
  3. Fill in your personal information accurately, including your last name, first name, middle initial, date of birth, and contact information, ensuring all fields are completed clearly.
  4. Provide your National Radon Proficiency Program (NRPP) identification numbers as necessary, and attach a copy of your current NRPP certification if applicable.
  5. In the 'Radon Measurement Services' section, list the detectors you will be using and the state-certified laboratory that will analyze these detectors, if required.
  6. Review the 'For Re-Licensing' section only if you're renewing an existing license, ensuring you include proof of continuing education and your previous Indiana license number(s) if applicable.
  7. Read the certification and signature section carefully. You will need to check off the appropriate categories, sign, and date the application to confirm the accuracy of the information provided.
  8. After completing the form, ensure all required documents are attached and then save your changes. You can choose to download, print, or share the completed form before submission.

Complete your IN State Form 45703 online today for a smooth application process.

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