AUTHORIZED USER TRAINING, EXPERIENCE, AND 

PRECEPTOR ATTESTATION 

(for uses defined under 35.300) 

[10 CFR 35.57, 35.390, 35.392, 35.394, and 35.396]

NRC FORM 313A (AUT)

(07-31-2023)

U. S. NUCLEAR REGULATORY COMMISSION

NRC FORM 313A (AUT) (07-31-2023) PAGE 1 

Name of Proposed Authorized User State or Territory Where Licensed

Requested Authorization(s) (check all that apply):

35.300 Use of unsealed byproduct material for which a written directive is required

OR

35.300 Oral administration of sodium iodide I-131 requiring a written directive in quantities less than or equal to 

1.22 gigabecquerels (33 millicuries)

35.300 Oral administration of sodium iodide I-131 requiring a written directive in quantities greater than 1.22 

gigabecquerels (33 millicuries)

35.300 Parenteral administration of any radioactive drug that contains a radionuclide that is primarily used for its 

electron emission, beta radiation characteristics, alpha radiation characteristics, or photon energy 

of less than 150 keV, for which a written directive is required.

Training and Experience, including board certification, must have been obtained within the 7 years preceding the 

date of application or the individual must have related continuing education and experience since the required 

training and experience was completed. Provide dates, duration, and description of continuing education and 

experience related to the uses checked above.

PART I -- TRAINING AND EXPERIENCE 

(Select one of the three methods below)

 1. Board Certification

a. Provide a copy of the board certification.

*

b. For 35.390, provide documentation on supervised case experience. The table in section 3.c. may be used to 

 document this experience.

c. For 35.396, provide documentation on classroom and laboratory training, supervised work experience, and 

 supervised clinical case experience. The tables in sections 3.a., 3.b., and 3.c. may be used to document this 

 experience. Skip to and complete Part II Preceptor Attestation.

d. For a board certification issued on or before October 24, 2005 that is listed in 10 CFR 35.57(b)(2)(ii), provide the 

 following:

(i) Documentation that the individual performed each use checked above on or before October 24, 2005.

(ii) Dates, duration, and description of continuing education and experience within the past seven years for 

 each use checked above.

e. Stop here.

 2. Current 35.300, 35.400, or 35.600 Authorized User Seeking Additional Authorization

a. Authorized User on Materials License under the requirements below or

equivalent Agreement State requirements (check all that apply):

35.390 35.392 35.394 35.490 35.690

b. If currently authorized for a subset of clinical uses under 35.300, provide documentation on additional required 

 supervised case experience. The table in section 3.c. may be used to document this experience. If board 

 certified, provide a copy of the certificate and stop here. If not board certified then provide completed Part II 

 Preceptor Attestation.

APPROVED BY OMB: NO. 3150-0120 EXPIRES: 07/31/2026

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 Infocollects.Resource@nrc.gov, 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; email: oira_submission@omb.eop.gov. 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.
NRC FORM 313A (AUT) U. S. NUCLEAR REGULATORY COMMISSION

(07-31-2023)

c. If currently authorized under 35.490 or 35.690 and requesting authorization for 35.396, provide documentation on 

classroom and laboratory training, supervised work experience, and supervised clinical case experience. The tables 

in sections 3.a., 3.b., and 3.c. may be used to document this experience. Also provide completed Part II Preceptor 

Attestation.

 3. Training and Experience for Proposed Authorized User

a. Classroom and Laboratory Training 

Description of Training

Radiation physics and 

instrumentation

Location of Training Clock 

Hours

Dates of 

Training*

Radiation protection

Mathematics pertaining to the 

use and measurement of 

radioactivity

Chemistry of byproduct 

material for medical use

35.390 35.392 35.394 35.396

Radiation biology

Total Hours of Training:

b. Supervised Work Experience 35.390 35.392 35.394 35.396

(If more than one supervising individual is necessary to document supervised training, provide multiple copies of this page.)

Description of Experience 

Must Include:

Ordering, receiving, and 

unpacking radioactive materials 

safely and performing the 

related radiation surveys

Location of Experience/License or 

Permit Number of Facility Confirm Dates of 

Experience*

Performing quality control 

procedures on instruments 

used to determine the activity 

of dosages and performing 

checks for proper operation of 

survey meters

Calculating, measuring, and 

safely preparing patient or 

human research subject 

dosages

Using administrative controls to 

prevent a medical event 

involving the use of unsealed 

byproduct material 

Using procedures to contain 

spilled byproduct material 

safely and using proper 

decontamination procedures 

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

Supervised Work Experience Total Hours of Experience:

NRC FORM 313A (AUT) (07-31-2023) PAGE 2 

AUTHORIZED USER TRAINING, EXPERIENCE, AND PRECEPTOR ATTESTATION 

(for uses defined under 35.300) [10 CFR 35.57, 35.390, 35.392, 35.394, and 35.396] (continued)
3. Training and Experience for Proposed Authorized User (continued)

b. Supervised Work Experience (continued)

NRC FORM 313A (AUT) U. S. NUCLEAR REGULATORY COMMISSION

(07-31-2023)

Supervising individual meets the requirements below, or equivalent Agreement State requirements 

(check all that apply)**:

35.390

35.392

35.394

35.396

With experience administering dosages of:

Oral NaI-131 requiring a written directive in quantities less than or equal to 1.22 

gigabecquerels (33 millicuries)

Oral NaI-131 in quantities greater than 1.22 gigabecquerels (33 millicuries)

Parenteral administration of any radioactive drug that contains a radionuclide that is primarily 

used for its electron emission, beta radiation characteristics, alpha radiation characteristics, 

or photon energy of less than 150 keV, for which a written directive is required.

Supervising Individual License/Permit Number listing supervising individual as an 

authorized user

Supervising Authorized User must have experience in administering dosages in the same dosage category or categories as the 

individual requesting authorized user status.

**

c. Supervised Clinical Case Experience

Description of Experience Location of Experience/License or Permit 

Number of Facility

Number of Cases 

Involving Personal 

Participation

Dates of 

Experience*

Parenteral administration of 

any radioactive drug that 

contains a radionuclide that is 

primarily used for its electron 

emission, beta radiation 

characteristics, alpha radiation 

characteristics, or photon 

energy of less than 150 keV, 

for which a written directive is 

required.

If more than one supervising individual is necessary to document supervised work experience, provide multiple copies of 

this page.

35.57

NRC FORM 313A (AUT) (07-31-2023) PAGE 3

AUTHORIZED USER TRAINING, EXPERIENCE, AND PRECEPTOR ATTESTATION 

(for uses defined under 35.300) [10 CFR 35.57, 35.390, 35.392, 35.394, and 35.396] (continued)

Oral administration of sodium 

iodide I-131 requiring a written 

directive in quantities greater 

than 1.22 gigabecquerels (33 

millicuries)

Oral administration of sodium 

iodide I-131 requiring a written 

directive in quantities less than 

or equal to 1.22 gigabecquerels 

(33 millicuries)
NRC FORM 313A (AUT) (07-31-2023)

3. Training and Experience for Proposed Authorized User (continued)

c. Supervised Clinical Case Experience (continued)

NRC FORM 313A (AUT) U. S. NUCLEAR REGULATORY COMMISSION

(07-31-2023)

d. Provide completed Part II Preceptor Attestation.

35.390

35.392

35.394

35.396

With experience administering dosages of:

Oral NaI-131 requiring a written directive in quantities less than or equal to 1.22 

gigabecquerels (33 millicuries)

Oral NaI-131 in quantities greater than 1.22 gigabecquerels (33 millicuries)

Parenteral administration of any radioactive drug that contains a radionuclide that is primarily 

used for its electron emission, beta radiation characteristics, alpha radiation characteristics, or 

photon energy of less than 150 keV, for which a written directive is required.

Supervising Authorized User must have experience in administering dosages in the same dosage category or categories 

as the individual requesting authorized user status.

**

Supervising individual meets the requirements below, or equivalent Agreement State requirements (check all that apply)**:

Supervising Individual License/Permit Number listing supervising individual as an 

authorized user

35.57

PART II – PRECEPTOR ATTESTATION

Note: This part must be completed by the individual's preceptor. The preceptor does not have to be the supervising 

individual as long as the preceptor provides, directs, or verifies training and experience required. If more than 

one preceptor is necessary to document experience, obtain a separate preceptor statement from each.

By checking the boxes below, the preceptor is not attesting to the individual's "general clinical competency."

First Section

Check one of the following for the requested authorization:

For 35.390:

I attest that 

Name of Proposed Authorized User

has satisfactorily completed the 700 hours of training

and experience, including a minimum of 200 hours of classroom and laboratory training, as required by 

10 CFR 35.390 (b)(1).

I attest that 

Name of Proposed Authorized User

has satisfactorily completed the 80 hours of classroom

and laboratory training, as required by 10 CFR 35.392(c)(1), and the supervised work and clinical case 

experience required in 35.392(c)(2).

For 35.392:

I attest that 

Name of Proposed Authorized User

has satisfactorily completed the 80 hours of classroom

and laboratory training, as required by 10 CFR 35.394 (c)(1), and the supervised work and clinical case 

experience required in 35.394(c)(2).

For 35.394:

PAGE 4 

AUTHORIZED USER TRAINING, EXPERIENCE, AND PRECEPTOR ATTESTATION 

(for uses defined under 35.300) [10 CFR 35.57, 35.390, 35.392, 35.394, and 35.396] (continued)
NRC FORM 313A (AUT) (07-31-2023)

I attest that 

Name of Proposed Authorized User

has satisfactorily completed the required clinical case

experience required in 35.390(b)(1)(ii)G listed below:

Oral NaI-131 requiring a written directive in quantities less than or equal to 1.22 

gigabecquerels (33 millicuries)

Oral NaI-131 in quantities greater than 1.22 gigabecquerels (33 millicuries)

Second Section

Third Section

I attest that 

Name of Proposed Authorized User

is able to independently fulfill the radiation safety-related

duties as an authorized user for the medical uses authorized under 10 CFR 35.300 for:

Oral NaI-131 requiring a written directive in quantities less than or equal to 1.22 

gigabecquerels (33 millicuries)

Oral NaI-131 in quantities greater than 1.22 gigabecquerels (33 millicuries)

For 35.396:

Current 35.490 or 35.690 authorized user:

Fourth Section

I attest that 

Name of Proposed Authorized User

is an authorized user under 10 CFR 35.490 or 35.690

or equivalent Agreement State requirements, has satisfactorily completed the 80 hours of classroom and 

laboratory training, as required by 10 CFR 35.396 (b)(1), and the supervised work and clinical case 

experience required by 35.396(b)(2), and is able to independently fulfill the radiation safety-related 

duties as an authorized user under 10 CFR 35.300 for:

OR

PAGE 5

NRC FORM 313A (AUT) U. S. NUCLEAR REGULATORY COMMISSION

(07-31-2023)

I attest that 

Name of Proposed Authorized User

has satisfactorily completed the board certification

requirements of 35.396(a)(3), has satisfactorily completed the 80 hours of classroom and laboratory 

training required by 10 CFR 35.396 (b)(1) and the supervised work and clinical case experience required by

35.396(b)(2), and is able to independently fulfill the radiation safety-related duties as an authorized user 

under 10 CFR 35.300 for: 

Board Certification:

AUTHORIZED USER TRAINING, EXPERIENCE, AND PRECEPTOR ATTESTATION 

(for uses defined under 35.300) [10 CFR 35.57, 35.390, 35.392, 35.394, and 35.396] (continued)

Parenteral administration of any radioactive drug that contains a radionuclide that is primarily 

used for its electron emission, beta radiation characteristics, alpha radiation characteristics, or 

photon energy of less than 150 keV, for which a written directive is required.

Parenteral administration of any radioactive drug that contains a radionuclide that is primarily 

used for its electron emission, beta radiation characteristics, alpha radiation characteristics, or 

photon energy of less than 150 keV, for which a written directive is required.

Parenteral administration of any radioactive drug that contains a radionuclide that is primarily 

used for its electron emission, beta radiation characteristics, alpha radiation characteristics, or 

photon energy of less than 150 keV, for which a written directive is required.
I meet the requirements below, or equivalent Agreement State requirements, as an authorized user for:

Fifth Section

Complete one of the following for the attestation and signature:

35.390 35.392 35.394 35.396

I have experience administering dosages in the following categories for which the proposed Authorized User is 

requesting authorization:

Oral NaI-131 requiring a written directive in quantities less than or equal to 1.22 gigabecquerels 

(33 millicuries)

Oral NaI-131 in quantities greater than 1.22 gigabecquerels (33 millicuries)

Name of Preceptor or Residency Program Director (Typed or Printed)

Signature

Telephone Number Date

NRC FORM 313A (AUT) (07-31-2023) PAGE 6

35.57 for 35.300 uses

OR

Residency Program Director:

I affirm that the attestation represents the consensus of the residency program faculty where at least one 

faculty member is an authorized user who meets the requirements below or equivalent Agreement State 

requirements:

35.390 35.392 35.394 35.396 35.57 for 35.300 uses

I affirm that this facility member has experience in administering dosages in the same dosage category or 

categories for which the individual is requesting authorized user status and concurs with the attestation I 

am providing as program director.

I affirm that the residency training program is approved by the:

Residency Review Committee of the Accreditation Council for Graduate Medical Education

Royal College of Physicians and Surgeons of Canada

Council on Post-Graduate Training of the American Osteopathic Association

I affirm that the residency training program includes training and experience specified in:

35.390 35.392 35.394 35.396

NRC FORM 313A (AUT) U. S. NUCLEAR REGULATORY COMMISSION

(07-31-2023)

Name of Facility: License/Permit Number:

Authorized User

AUTHORIZED USER TRAINING, EXPERIENCE, AND PRECEPTOR ATTESTATION 

(for uses defined under 35.300) [10 CFR 35.57, 35.390, 35.392, 35.394, and 35.396] (continued)

Parenteral administration of any radioactive drug that contains a radionuclide that is primarily 

used for its electron emission, beta radiation characteristics, alpha radiation characteristics, or 

photon energy of less than 150 keV, for which a written directive is required.