Maryland Radioactive Materials Licensing Forms
Forms and Information
Updated: New locations for Disposal of Unwanted Radioactive Material
Maryland Radioactive Materials Application (pdf)
In-vitro Certificate (pdf)
Notice to Employees (pdf)
Pre-licensing Visit (pdf)
Occupational Dose Record for a Monitoring Period (pdf)
Radioactive Materials License - general information
Radiological Health Licensing Guidance
Information needed for transfer of control and/or change of name for radioactive materials licensees
Preceptor Attestation Forms
Radioactive Material Licensing Fees
Sealed Source and Device Fees
Notifying MDE of reciprocity requests
Reciprocity Notification (.doc). This form should be completed, saved on your computer or network, and then e-mailed to firstname.lastname@example.org.
General Information on Reciprocity
General License Registration
Registering a General License Device - Information
Instructions for Completion of General License Device Registration Form
NOTE: For the following forms, do not left-click on the link. Instead, right-click, and a menu will appear. On the menu, select "Save Target As". Then select the folder on your computer or network in which you wish to save the form. This will assist you in locating the form on your computer to complete it.
General License Device Registration Form. After saving this form as described above, complete the form on your computer or network, save it with the name general_license, and then e-mail the file as an attachment to email@example.com.
General License Device Certification. Possessors of certain types of general license devices must complete, sign, and mail this certification to the Department.
General License Payment Transmittal Form. Must accompany your payment for your initial registration of a general license device.
Transfer Declaration Form. To be completed and mailed to the Department if you no longer possess a general license device.
NOTE ON RETURN OF DEVICES AND RECEIPT OF NEW DEVICES. When a general license device is returned to the manufacturer or other specific licensee authorized to receive such device, you are required to report this transfer to MDE by using the Transfer Declaration Form, in accordance with COMAR 26.12.01.01C.22(d)(4)(viii). The transferred device will be removed from the Department's database. If you obtain additional or replacement devices, you are required to report these new devices to the Department within 30 days of receipt by submitting a new General License Device Registration Form. The new devices will be added to the Department's database. These notifications are necessary for MDE to maintain current information on general license devices in Maryland.
NOTE ON ANNUAL REGISTRATION UPDATE. An annual update of registration information is required, in accordance with COMAR 26.12.01.01C.22(k)(1). Instructions for this update will be provided with your annual invoice. If you have any questions about this annual update, please e-mail your inquiry to firstname.lastname@example.org or call Mr. Jim Lewis at 410-537-3300.
NOTE ON BANKRUPTCY OF CERTAIN GENERAL LICENSEES. Each general licensee possessing radioactive material devices that contain at least 370 MBq (10 mCi) of cesium-137, 3.7 MBq (0.1 mCi) of strontium-90, 37 MBq (1 mCi) of cobalt-60, or 37 MBq (1 mCi) of americium-241 or any other transuranic element (i.e., element with atomic number greater than uranium (92), based on the activity indicated on the label), shall notify the Agency in writing immediately following the filing of a voluntary or involuntary petition for bankruptcy under any Chapter of Title 11 (Bankruptcy) of the United States Code by or against:
(1) the licensee;
(2) an entity (as that term is defined in 11 U.S.C. 101(14)) controlling the licensee or listing the license or licensee as property of the estate; or
(3) an affiliate (as that term is defined in 11 U.S.C. 101(2)) of the licensee.
The above notification shall indicate the bankruptcy court in which the petition for bankruptcy was filed, a copy of the bankruptcy petition, and the date of the filing of the petition.
For information on licensing of radioactive materials please contact Barbara Park at email@example.com. For information regarding reciprocity or general licensing please contact Jim Lewis at firstname.lastname@example.org. Ms. Park and Mr. Lewis may be reached at 410-537-3301.
Tritium Sign Information (Environmental Protection Agency)
Radiological Health Program Home
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