NRC Form 749, "Manual License Verification Report."

When a licensee is unable to use the License Verification System to perform their license verification prior to transferring radioactive materials in quantities of concern, a manual process is available, in which licensees submit the NRC Form 749, “Manual License Verification Report.” The form provides the information necessary for the license issuing agencies to perform the verification on behalf of the licensee transferring the radioactive materials.

The latest form for NRC Form 749, "Manual License Verification Report." expires 2021-01-31 and can be found here.