| Form (Fillable PDF Format) | Regulatory Guide |
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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. | |
 Delegation of Authority Model - With/Without Signing Authority
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Delegation of Authority Model - Ability to Make Legally Binding Statements
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Healing Arts Screening Form
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| NRH-1 - Cumulative Occupational Exposure History | 3.4,
3.13,
4.0,
4.5 |
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NRH-2 - Occupational Exposure Record for a Monitoring Period | 3.4,
3.13,
4.0,
4.1,
4.5 |
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NRH-3 - Notice to Employees - Standards for Protection Against Radiation; Notices, Instructions and Reports to Workers; Inspections | 3.4,
3.13 |
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NRH-3 (SPAN) - Aviso a los empleados - Estándares para protegerse de la radiaci ó n; Avisos, instrucciones y reportes para los empleados; Inspecciones |
3.4,
3.13 |
| NRH-3D - Notice to Employees - Standards for Protection Against Radiation; Notices, Instructions and Reports to Workers; Inspections (For Dental Facilities Only) |
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| NRH-3D (SPAN) - 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) |
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NRH-4 (INST) - Instructions for NRH-4 - Application for Registration of Radiation Generating Equipment
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NRH-4 - Application for Registration of Radiation Generating Equipment and U.S. Citizenship Attestation Form | 6.0,
6.2,
6.3,
6.4
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NRH-4A - Application Supplement for Additional Machines
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NRH-4B - Registered Facility Radiation Generating Equipment Update
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NRH-4C - Registration Termination/Close Application for Radiation Generating Equipment
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| NRH-5 - Application for Radioactive Material License and U.S. Citizenship Attestation Form | 3.2,
3.4,
3.5,
3.6,
3.13,
5.0,
12, OR
19 |
NRH-6 - Dental Interim Inspection Form
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NRH-6A - Equipment List
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NRH-6B - Equipment Performance Evaluation Dental Unit
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NRH-7 - Application for Radioactive Material License - Medical and U.S. Citizenship Attestation Form
| 7.0 |
| 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.) | 7.0 Supplement |
| NRH-9 - Application for Registration of Services for Radiation Generating Equipment and U.S. Citizenship Attestation Form | 2.1 |
| NRH-9 (INST) - Instructions for NRH-9 - Application for Registration of Services for Radiation Sources | |
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NRH-11 - Certificate-Use of Depleted Uranium Under General License | |
| NRH-17 - Certificate - In Vitro Testing with Radioactive Material Under General License |
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NRH-60 - Certification of Disposition of Materials
| 3.4,
3.13 |
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NRH-653,
653A,
653B - Transfers of Industrial Devices Report |
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Sample of Records Location Card
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