Number and Title of Form |
Refer to Regulatory (RG) guide for additonal information |
 PDF File |
Word Document |
| Citizenship Attestation Form - All licensees and registrants are required to complete this form and have it on file per Neb. Rev. §§ 4-108 through 4-114. |
- |
U.S. Citizenship Attestation |
U.S. Citizenship Attestation |
| NRH - 1, Cumulative Occupational Exposure History |
RG 3.4, RG 3.13,RG 4.0, RG 4.5 |
NRH - 1 |
NRH-1 |
| NRH - 2, Occupational Exposure Record for a Monitoring Period |
RG 3.4, RG 3.13,RG 4.0, RG 4.1,RG 4.5 |
NRH-2 |
NRH-2 |
| NRH - 3, Notice to Employees - Standards for Protection Against Radiation; Notices, Instructions and Reports to Workers; Inspections |
RG 3.4, RG 3.13 |
NRH-3 |
NRH-3 |
| (SPAN) NRH - 3, Aviso a los empleados - Estándares para protegerse de la radiaci ó n; Avisos, instrucciones y reportes para los empleados; Inspecciones |
RG 3.4, RG 3.13 |
NRH-3 |
NRH-3 |
| NRH - 3D, Notice to Employees - Standards for Protection Against Radiation; Notices, Instructions and Reports to Workers; Inspections (For Dental Facilities Only) |
RG 21 |
NRH-3D |
NRH-3D |
| (SPAN) NRH – 3D, Aviso a los empleados - Estándares para protegerse de la radiaci ó n; Avisos, instrucciones y reportes para los empleados; Inspecciones (exclusivamente para establecimientos de servicios dentales) |
RG 21 |
NRH-3D |
NRH-3D |
| NRH -4, Application for Registration of Radiation Generating Equipment and U.S. Citizenship Attestation Form |
RG 6.0, 6.2, 6.3, 6.4 OR 21 |
NRH-4 |
NRH-4 |
| NRH - 4a, Application for Registration of Radiation Generating Equipment (Additional Machines) |
- |
NRH-4a |
NRH-4a |
| NRH -4 (Inst) Instructions for NRH-4 - Application for Registration of Radiation Generating Equipment |
- |
NRH-4 Inst. |
NA |
| NRH -5, Application for Radioactive Material License and U.S. Citizenship Attestation Form |
RG 3.2, 3.4,3.5,3.6,3.13,5.0, 12, OR 19 |
NRH-5 |
NRH-5 |
| NRH -7, Application for Radioactive Material License - Medical and U.S. Citizenship Attestation Form |
RG 7.0 |
NRH-7 |
NRH-7 |
| NRH-7A Medical Use Training and Experience and Preceptor Attestation (Refer to Regulatory Guide 7.0 Supplement for Attestation for the different types of medical licenses form.) |
RG 7.0 Supplement |
NRH-7A |
NRH-7A |
| NRH - 9, Application for Registration of Services for Radiation Generating Equipments and U.S. Citizenship Attestation Form |
RG 2.1 |
NRH-9 |
NRH-9 |
| NRH - 9 (Inst) Instructions for NRH-9 Application for Registration of Services for Radiation Sources |
- |
NRH-9 Inst. |
NA |
| NRH - 11, Certificate-Use of Depleted Uranium Under General License |
- |
NRH-11 |
NRH-11 |
| NRH - 17, Certificate - In Vitro Testing with Radioactive Material Under General License |
- |
NRH-17 |
NRH-17 |
| NRH-21 Dental Interim Inspection Form |
- RG 21 |
NRH-21 |
NRH-21 |
| NRH-21A Equipment List |
- RG 21 |
NRH-21A |
NRH-21A |
| NRH-21B Equipment Performance Evaluation Dental Unit |
- RG 21 |
NRH-21B |
NRH-21B |
| NRH - 60, Certification of Disposition of Materials |
- RG 3.4, RG 3.13 |
NRH-60 |
NRH-60 |
| NRH - 653, 653 Continued, 653A & 653B Transfers of Industrial Devices Report |
- |
NRH 653, NRH 653ANRH 653B |
NRH 653, NRH 653A NRH 653B |
| Sample of card to post showing where records are located |
- |
Card |
Card |
| (SPAN) Muestra de la tarjeta a publicar para mostrar dónde se encuentran los documentos |
- |
Card |
Card |