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NRC Form 313A(AMP) - Authorized Medical Physicist Training and Experience and Preceptor Attestation (for uses defined under 35.51)

Form Number: NRC Form 313A(AMP) PDF Icon
Form Title: Authorized Medical Physicist Training and Experience and Preceptor Attestation (for uses defined under 35.51)
Current Edition: 06-2016
Authority Directive or Regulation: 10 CFR 35
Form Status: Approved by OMB: 3150-0120, Expires: 06/30/2019
Special Instructions:

Send Completed Application for Distribution of Exempt Products to:

NMSS/MSTR/Materials Safety Licensing Branch
Mail Stop: T8E18
U. S. Nuclear Regulatory Commission
Washington, DC 20555-0001
For Questions: E-mail: LBLicensingAssistant.Resource@nrc.gov

If you are located in:
Alabama, Connecticut, Delaware, District of Columbia, Florida, Georgia, Kentucky, Maine, Maryland, Massachusetts, New Hampshire, New Jersey, New York, North Carolina, Pennsylvania, Puerto Rico, Rhode Island, South Carolina, Tennessee, Vermont, Virginia, Virgin Islands, or West Virginia:

Licensing Assistance Team
Division of Nuclear Materials Safety
U.S. Nuclear Regulatory Commission, Region I
2100 Renaissance Boulevard, Suite 100
King of Prussia, PA 19406-2713
Questions: (610) 337-5260, (610) 337-5313, (610) 337-5398, (610) 337-5513 or (610) 337-5239

If you are located in:
Illinois, Indiana, Iowa, Michigan, Minnesota, Missouri, Ohio, or Wisconsin:

DNMS/Materials Licensing Branch
U.S. Nuclear Regulatory Commission, Region III
2443 Warrenville Road, Suite 210
Lisle, IL 60532-4352
For Questions: (630) 829-9887, (630) 829-9500 or (800) 522-3025

If you are located in:
Alaska, Arizona, Arkansas, California, Colorado, Hawaii, Idaho, Kansas, Louisiana, Mississippi, Montana, Nebraska, Nevada, New Mexico, North Dakota, Oklahoma, Oregon, Pacific Trust Territories, South Dakota, Texas, Utah, Washington, or Wyoming.

DNMS/NMSB - B
U.S. Nuclear Regulatory Commission, Region IV
1600 E. Lamar Boulevard
Arlington, TX 76011-4511
For Questions: (817) 200-1103 or (817) 200-1140

PERSONS LOCATED IN AGREEMENT STATES SEND APPLICATIONS TO THE U.S. NUCLEAR REGULATORY COMMISSION ONLY IF THEY WISH TO POSSESS AND USE LICENSED MATERIAL IN STATES SUBJECT TO U.S. NUCLEAR REGULATORY COMMISSION JURISDICATION.

Agreement and Non-Agreement States

Page Last Reviewed/Updated Friday, June 17, 2016