NRC FORM 313

(10-13-2023)

10 CFR 30, 32, 

33, 34, 35, 36, 

37, 39, and 40

U.S. NUCLEAR REGULATORY COMMISSION

APPLICATION FOR 

MATERIALS LICENSE

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.

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.

APPLICATION FOR DISTRIBUTION OF EXEMPT PRODUCTS FILE APPLICATIONS WITH:

MATERIALS SAFETY AND TRIBAL LIAISON BRANCH 

DIVISION OF MATERIALS SAFETY, SECURITY, STATE AND TRIBAL PROGRAMS 

OFFICE OF NUCLEAR MATERIALS SAFETY AND SAFEGUARDS 

U.S. NUCLEAR REGULATORY COMMISSION 

WASHINGTON, DC 20555-0001

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:

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 

R1DRSSMail.Resource@nrc.gov

*Note: The preferred method to submit NRC Form 313 is email. Any other document (e.g., 

financial assurance documents) should be sent via mail.

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 

2443 WARRENVILLE ROAD, SUITE 210 

LISLE, IL 60532-4352 

R3-DRSSMAIL.Resource@nrc.gov

*Note: The preferred method to submit NRC Form 313 is email. Any other document (e.g., financial 

assurance documents) should be sent via mail.

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:

MATERIALS LICENSING BRANCH 

DIVISION OF RADIOLOGICAL SAFETY AND SECURITY 

U.S. NUCLEAR REGULATORY COMMISSION, REGION IV 

1600 E. LAMAR BOULEVARD 

ARLINGTON, TX 76011-4511 

R4licensing@nrc.gov

*Note: The preferred method to submit NRC Form 313 is email. Any other document (e.g., financial 

assurance documents) should be sent via mail.

PERSONS LOCATED IN AGREEMENT STATES SEND APPLICATIONS TO THE U.S. NUCLEAR REGULATORY COMMISSION ONLY IF THEY WISH TO POSSESS AND USE LICENSED MATERIAL 

IN STATES SUBJECT TO U.S. NUCLEAR REGULATORY COMMISSION JURISDICTIONS.

1. THIS IS AN APPLICATION FOR (Check appropriate item)

A. NEW LICENSE

B. AMENDMENT TO LICENSE NUMBER

C. RENEWAL OF LICENSE NUMBER

2. NAME AND MAILING ADDRESS OF APPLICANT (Include zip code)

3. LIST 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

BUSINESS TELEPHONE NUMBER BUSINESS CELLULAR TELEPHONE NUMBER

BUSINESS E-MAIL ADDRESS

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; and 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, with few exceptions*) 

 (See 10 CFR 170 and Section 170.31) 

 *Amendments/Renewals that increase the scope of the existing license to a new or higher fee category will require a fee. 

FEE 

CATEGORY

AMOUNT 

ENCLOSED $

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. FAX THE COMPLETED NRC FORM 531 TO (301) 415-6725. 

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, 32, 33, 34, 35, 36, 37, 39, AND 40, 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/PRINTED NAME AND TITLE SIGNATURE DATE

TYPE OF FEE FEE LOG FEE CATEGORY AMOUNT RECEIVED $ CHECK NUMBER

 APPROVED BY DATE

 COMMENTS

NRC FORM 313 (10-13-2023)

FOR NRC USE ONLY