Get General License Registration Form

Filling out the General License Registration Form is an important step for individuals or organizations looking to acquire, receive, possess, use, or transfer radioactive materials. This guide will walk you through each section of the form to ensure your submission is complete and accurate.

Follow the steps to fill out the General License Registration Form online effectively.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Provide your facility information. Start with the applicant name, facility address, city, state, country, and zip code. These details should clearly identify your location and responsible entity.
3. Enter your email address or cellphone number to ensure timely communication. Include a telephone number to facilitate any follow-up inquiries.
4. Fill in the contact person's information, including their email address and telephone number. This should be someone knowledgeable about the application and available for questions.
5. List the radiation contact individual, providing their email address and telephone number for any radiation-specific communication.
6. In the device information section, indicate the number of devices and/or sources. Specify the device type, manufacturer, model number, and serial number for each device.
7. Answer whether the device has been leak tested by selecting ‘Yes’ or ‘No’. If yes, provide the date it was received and the frequency of testing performed.
8. Identify the individual or entity responsible for performing the leak tests to ensure proper accountability.
9. Describe the method you will use for disposing of the devices accurately, mentioning options such as returning to the manufacturer if applicable.
10. Review the certification statement, confirming that the registration information is correct to your knowledge. Sign and date the form where indicated.
11. Once completed, save your changes. You can then download, print, or share the form as necessary for submission.

Complete your General License Registration Form online and ensure compliance.