APPLICATION FOR MATERIALS LICENSE

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NRC FORM 313
(MM-DD-YYYY)
10 CFR 30, 32,
33, 34, 35, 36,
37, 39, and 40

U.S. NUCLEAR REGULATORY COMMISSION

APPLICATION FOR
MATERIALS LICENSE

EXPIRES: (MM/DD/YYYY)

APPROVED BY OMB: NO. 3150-0120

Estimated burden per response to comply with this mandatory collection request: 4.3 hours. Submittal of the application is necessary
to determine that the applicant is qualified and that adequate procedures exist to protect the public health and safety. Send
comments regarding burden estimate to the FOIA, Library, and Information Collections Branch (T-6 A10M), U. S. Nuclear Regulatory
Commission, Washington, DC 20555-0001, or by email to [email protected], and the OMB Reviewer at: OMB Office of
Information and Regulatory Affairs, (3150-0120), Attn: Desk Officer for the Nuclear Regulatory Commission, 725 17th Street NW,
Washington, DC 20503. The NRC may not conduct or sponsor, and a person is not required to respond to, a collection of
information unless the document requesting or requiring the collection displays a currently valid OMB control number.

INSTRUCTIONS: SEE THE CURRENT VOLUMES OF THE NUREG-1556 TECHNICAL REPORT SERIES (“CONSOLIDATED GUIDANCE
ABOUT MATERIALS LICENSES”) FOR DETAILED INSTRUCTIONS FOR COMPLETING THIS FORM:
http://www.nrc.gov/reading-rm/doc-collections/nuregs/staff/sr1556/. SEND ONE COPY OF THE COMPLETED APPLICATION TO THE
NRC OFFICE SPECIFIED BELOW OR ONLINE AT https://www.nrc.gov/security/byproduct/ismp/wbl.html.
DO NOT USE THIS FORM FOR TERMINATIONS, INSTEAD USE NRC FORM 314.
APPLICATION FOR DISTRIBUTION OF EXEMPT PRODUCTS FILE APPLICATIONS WITH:
MATERIALS SAFETY AND LICENSING BRANCH
DIVISION OF MATERIALS SAFETY, SECURITY, STATE AND TRIBAL PROGRAMS
OFFICE OF NUCLEAR MATERIALS SAFETY AND SAFEGUARDS
U.S. NUCLEAR REGULATORY COMMISSION
11555 ROCKVILLE PIKE
ROCKVILLE, MD 20852-2738
*NOTE: The preferred method to submit NRC Form 313 is online at
https://www.nrc.gov/security/byproduct/ismp/wbl.html or email at
[email protected].
Any other documents (e.g., financial assurance documents) should be sent via email.

ALL OTHER PERSONS FILE APPLICATIONS AS FOLLOWS:
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.
SEND APPLICATIONS TO:

IF YOU ARE LOCATED IN:
ILLINOIS, INDIANA, IOWA, MICHIGAN, MINNESOTA, MISSOURI, OHIO, OR
WISCONSIN.
SEND APPLICATIONS TO:
MATERIALS LICENSING BRANCH
DIVISION OF RADIOLOGICAL SAFETY AND SECURITY
U.S. NUCLEAR REGULATORY COMMISSION, REGION III
2056 WESTINGS AVENUE, SUITE 400
NAPERVILLE, IL 60563-2657
*NOTE: The preferred method to submit NRC Form 313 is online at
https://www.nrc.gov/security/byproduct/ismp/wbl.html or email at
[email protected].
Any other documents (e.g., financial assurance documents) should be sent via email.
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.
SEND APPLICATIONS TO:

LICENSING ASSISTANCE TEAM
DIVISION OF RADIOLOGICAL SAFETY AND SECURITY
U.S. NUCLEAR REGULATORY COMMISSION, REGION I
475 ALLENDALE ROAD, SUITE 102
KING OF PRUSSIA, PA 19406-1415

MATERIALS LICENSING BRANCH
DIVISION OF RADIOLOGICAL SAFETY AND SECURITY
U.S. NUCLEAR REGULATORY COMMISSION, REGION IV
1600 E. LAMAR BOULEVARD
ARLINGTON, TX 76011-4511

*NOTE: The preferred method to submit NRC Form 313 is online at
https://www.nrc.gov/security/byproduct/ismp/wbl.html or email at
[email protected].
Any other documents (e.g., financial assurance documents) should be sent via email.

*NOTE: The preferred method to submit NRC Form 313 is online at
https://www.nrc.gov/security/byproduct/ismp/wbl.html or email at
[email protected].
Any other documents (e.g., financial assurance documents) should be sent via email.

Persons located in Agreement States should send Applications to the U.S. Nuclear Regulatory Commission using this form only if: (1)
they wish to use or possess licensed byproduct material, source material, or special nuclear material of less than a critical mass in
non-Agreement states, the District of Columbia, or other areas of exclusive Federal Jurisdiction, such as offshore Federal waters, U.S.
territories or possessions, and most Indian Tribal lands; (2) they wish to distribute Exempt Products; and/or (3) they represent a
Federal Agency other than the Department of Energy and its prime contractors.
1. This is an application for (Check appropriate item)

2a. Applicant name (Proposed licensee name)

A. New License
B. Amendment to Existing License Number
C. Renewal of License Number

2b. Mailing address of applicant (Include zip code)

3. List location title (if available, such as XYZ Hospital) with address and/or temporary job
site (TJS) address, where licensed materials will be used or possessed.

4. Name of person to be contacted about this application. (First/Middle/Last)

Business telephone number

Business cellular telephone number

Business email address

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NRC FORM 313

U.S. NUCLEAR REGULATORY COMMISSION

(MM-DD-YYYY)

APPLICATION FOR MATERIALS LICENSE (Continued)
Please refer to NRC's Materials Prospective Applicant and Pre-application Engagement Resources and Frequently Asked Questions at:
https://www.nrc.gov/materials/miau/engagement-resources.
Please confirm that all supporting information uses the format recommended in the corresponding NUREG 1556, Appendix B. An optional application
completeness checklist is provided for completion at ML26043A407.
SUBMIT ITEMS 5 THROUGH 11 ON 8-1/2 X 11 PAPER. THE TYPE AND SCOPE OF INFORMATION TO BE PROVIDED IS DESCRIBED IN
THE APPLICABLE LICENSING GUIDANCE.
5. RADIOACTIVE MATERIAL
a. Element and mass number.
b. Chemical and/or physical form.
c. Maximum amount which will be possessed at any one time.
6. PURPOSE(S) FOR WHICH LICENSED MATERIAL WILL BE USED.
7. INDIVIDUAL(S) RESPONSIBLE FOR RADIATION SAFETY PROGRAM AND THEIR TRAINING AND EXPERIENCE.
8. TRAINING FOR INDIVIDUALS WORKING IN OR FREQUENTING RESTRICTED AREAS.
9. FACILITIES AND EQUIPMENT.
10. RADIATION SAFETY PROGRAM.
11. WASTE MANAGEMENT.
12. LICENSE FEES (Fees required only for new applications, at time of application submission, with few exceptions*)(See 10 CFR 170 and Section 170.31)
For fee questions, contact the NRC Office of the Chief Financial Officer at (301) 415-7554 or email [email protected].
*Amendments/Renewals that increase the scope of the existing license to a new or higher fee category will require a fee.

FEE CATEGORY

AMOUNT TO BE PAID VIA www.pay.gov

$

PER THE DEBT COLLECTION IMPROVEMENT ACT OF 1996 (PUBLIC LAW 104-134), YOU ARE REQUIRED TO PROVIDE YOUR TAXPAYER
IDENTIFICATION NUMBER. PROVIDE THIS INFORMATION BY COMPLETING NRC FORM 531:
https://www.nrc.gov/reading-rm/doc-collections/forms/nrc531info.html. EMAIL THE COMPLETED NRC FORM 531 TO: [email protected]
13. CERTIFICATION. (Must be completed by applicant) THE APPLICANT UNDERSTANDS THAT ALL STATEMENTS AND REPRESENTATIONS MADE IN
THIS APPLICATION ARE BINDING UPON THE APPLICANT.
THE APPLICANT AND ANY OFFICIAL EXECUTING THIS CERTIFICATION ON BEHALF OF THE APPLICANT, NAMED IN ITEM 2, CERTIFY THAT THIS
APPLICATION IS PREPARED IN CONFORMITY WITH TITLE 10, CODE OF FEDERAL REGULATIONS, PARTS 30, 31, 32, 33, 34, 35, 36, 37, 39, 40, 70, AND
71, AND THAT ALL INFORMATION CONTAINED HEREIN IS TRUE AND CORRECT TO THE BEST OF THEIR KNOWLEDGE AND BELIEF.
WARNING: 18 U.S.C. SECTION 1001 ACT OF JUNE 25, 1948, 62 STAT. 749 MAKES IT A CRIMINAL OFFENSE TO MAKE A WILLFULLY FALSE STATEMENT
OR REPRESENTATION TO ANY DEPARTMENT OR AGENCY OF THE UNITED STATES AS TO ANY MATTER WITHIN ITS JURISDICTION.
Certifying Officer -- Typed or Printed Name and Title

Signature

Date (MM/DD/YYYY)

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