AUTHORIZED USER TRAINING, EXPERIENCE 

AND PRECEPTOR ATTESTATION 

(for uses defined under 35.400 and 35.600) 

[10 CFR 35.57, 35.490, 35.491, and 35.690]

NRC FORM 313A (AUS)

(07-31-2023)

U. S. NUCLEAR REGULATORY COMMISSION

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

Name of Proposed Authorized User State or Territory Where Licensed

Requested 

Authorization(s) 

(check all that apply)

35.400 Manual brachytherapy sources

35.400 Ophthalmic use of strontium-90

35.600 Remote afterloader unit(s)

35.600 Teletherapy unit(s)

35.600 Gamma stereotactic radiosurgery unit(s)

PART I -- TRAINING AND EXPERIENCE 

(Select one of the three methods below)

*Training and Experience, including Board Certification, must have been obtained within the 7 years preceding the date 

 of application or the individual must have obtained 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.

 1. Board Certification

a. Provide a copy of the board certification.

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

 provide the following:

b. For 35.690, go to the table in 3.e. and describe training provider and dates of training for each type of use for

 which authorization is sought.

2. Current 35.600 Authorized User Requesting Additional Authorization for 35.600 Use(s) Checked Above

a. Go to the table in section 3.e. to document training for new device. 

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

 Part II Preceptor Attestation.

(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.

d. Stop here.

a. Classroom and Laboratory Training 

 3. Training and Experience for Proposed Authorized User

Description of Training

Radiation physics and 

instrumentation

Location of Training Clock 

Hours

Radiation protection

Mathematics pertaining to the 

use and measurement of 

radioactivity

35.490 35.491 35.690

Radiation biology

Total Hours of Training:

Dates of 

Training*

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 (AUS)

(07-31-2023)

U. S. NUCLEAR REGULATORY COMMISSION

AUTHORIZED USER TRAINING, EXPERIENCE AND PRECEPTOR ATTESTATION 

(for uses defined under 35.400 and 35.600) 

[10 CFR 35.57, 35.490, 35.491, and 35.690] (continued)

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

b. Supervised Work and Clinical Experience for 10 CFR 35.490 (If more than one supervising individual is 

 necessary to document supervised work experience, provide multiple copies of this page.)

Description of Experience 

Must Include:

Preparing, implanting, and safely 

removing brachytherapy sources

Location of Experience/License or 

Permit Number of Facility Confirm Dates of Experience*

Maintaining running inventories 

of material on hand

PAGE 2

Checking survey meters for 

proper operation

Ordering, receiving, and 

unpacking radioactive materials 

safely and performing the related 

radiation surveys

Using administrative controls to 

prevent a medical event 

involving the use of byproduct 

material

Using emergency procedures to 

control byproduct material

Council on Postdoctoral 

Training of the American 

Osteopathic Association

Residency Review 

Committee for Radiation 

Oncology of the ACGME

Approved by:

Royal College of Physicians 

and Surgeons of Canada

Location of Experience/License or 

Permit Number of Facility

Dates of 

Experience*

Clinical experience in radiation 

oncology as part of an approved 

formal training program

Supervising Individual License/Permit Number listing supervising individual as an

Authorized User

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Supervised Work Experience Total Hours of Experience:

NRC FORM 313A (AUS) (07-31-2023)
NRC FORM 313A (AUS)

(07-31-2023)

U. S. NUCLEAR REGULATORY COMMISSION

AUTHORIZED USER TRAINING, EXPERIENCE AND PRECEPTOR ATTESTATION 

(for uses defined under 35.400 and 35.600) 

[10 CFR 35.57, 35.490, 35.491, and 35.690] (continued)

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

PAGE 3

c. Supervised Clinical Experience for 10 CFR 35.491

Description of Experience

Use of strontium-90 for 

ophthalmic treatment, including: 

examination of each individual to 

be treated; calculation of the 

dose to be administered; 

administration of the dose; and 

follow up and review of each 

individual's case history

Location of Experience/License or 

Permit Number of Facility

Clock 

Hours

Dates of 

Experience*

Supervising Individual License/Permit Number listing supervising individual as an

Authorized User

Remote afterloader unit(s) Teletherapy unit(s) Gamma stereotactic radiosurgery unit(s)

d. Supervised Work and Clinical Experience for 10 CFR 35.690

Description of Experience 

Must Include:

Location of Experience/License or 

Permit Number of Facility Confirm Dates of 

Experience*

Reviewing full calibration 

measurements and periodic 

spot-checks

Preparing treatment plans and 

calculating treatment doses and 

times

Using administrative controls to 

prevent a medical event 

involving the use of byproduct 

material

Implementing emergency 

procedures to be followed in the 

event of the abnormal operation 

of the medical unit or console

Checking and using survey 

meters

Selecting the proper dose and 

how it is to be administered

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

Supervised Work Experience Total Hours of Experience:

NRC FORM 313A (AUS) (07-31-2023)
NRC FORM 313A (AUS)

(07-31-2023)

U. S. NUCLEAR REGULATORY COMMISSION

AUTHORIZED USER TRAINING, EXPERIENCE AND PRECEPTOR ATTESTATION 

(for uses defined under 35.400 and 35.600) 

[10 CFR 35.57, 35.490, 35.491, and 35.690] (continued)

Description 

of Training Training Provider and Dates

Remote Afterloader Teletherapy Gamma Stereotactic 

Radiosurgery 

Device operation

Safety procedures 

for the device use

Clinical use of the 

device

f. Provide completed Part II Preceptor Attestation.

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

For 35.600, describe training provider and dates of training for each type of use for which authorization is 

sought.

e.

License/Permit Number listing supervising individual as an 

Authorized User

Council on Postdoctoral 

Training of the American 

Osteopathic Association

Residency Review 

Committee for Radiation 

Oncology of the ACGME

Approved by:

Royal College of Physicians 

and Surgeons of Canada

Location of Experience/License or 

Permit Number of Facility

Dates of 

Experience*

Clinical experience in radiation 

oncology as part of an approved 

formal training program

Supervising Individual License/Permit Number listing supervising individual as an

Authorized User

d. Supervised Work and Clinical Experience for 10 CFR 35.690 (continued)

PAGE 4 

Authorized for the following types of use:

Remote afterloader unit(s) Teletherapy unit(s) Gamma stereotactic radiosurgery unit(s)

Supervising Individual. (If training provided by Supervising 

Individual (If more than one supervising individual is necessary 

to document supervised work experience, provide multiple 

copies of this page.)

NRC FORM 313A (AUS) (07-31-2023)
NRC FORM 313A (AUS)

(07-31-2023)

U. S. NUCLEAR REGULATORY COMMISSION

AUTHORIZED USER TRAINING, EXPERIENCE AND PRECEPTOR ATTESTATION 

(for uses defined under 35.400 and 35.600) 

[10 CFR 35.57, 35.490, 35.491, and 35.690] (continued)

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.

First Section

Check one of the following for each requested authorization:

For 35.490:

By checking the boxes below, the preceptor is attesting that the individual has knowledge to fulfill the duties of 

the position sought and not attesting to the individual's "general clinical competency."

I attest that 

Name of Proposed Authorized User

has satisfactorily completed the 200 hours of

classroom and laboratory training, 500 hours of supervised work experience, and 3 years of supervised 

clinical experience in radiation oncology, as required by 10 CFR 35.490(b)(1) and (b)(2), and is able to 

independently fulfill the radiation safety-related duties as an authorized user of manual brachytherapy 

sources for the medical uses authorized under 10 CFR 35.400.

For 35.491:

I attest that 

Name of Proposed Authorized User

has satisfactorily completed the 24 hours of

classroom and laboratory training applicable to the medical use of strontium-90 for ophthalmic radiotherapy, 

has used strontium-90 for ophthalmic treatment of 5 individuals, as required by 10 CFR 35.491(b), and is 

able to independently fulfill the radiation safety-related duties as an authorized user of strontium-90 for 

ophthalmic use.

For 35.690:

Second Section

I attest that 

Name of Proposed Authorized User

has satisfactorily completed 200 hours of classroom

and laboratory training, 500 hours of supervised work experience, and 3 years of supervised clinical 

experience in radiation therapy, as required by 10 CFR 35.690(b)(1) and (b)(2).

AND

For 35.690: (continued)

I attest that 

Name of Proposed Authorized User

has received training required in 35.690(c) for device

operation, safety procedures, and clinical use for the type(s) of use for which authorization is sought, as 

checked below.

Remote afterloader unit(s) Teletherapy unit(s) Gamma stereotactic radiosurgery unit(s)

Third Section

AND

NRC FORM 313A (AUS) (07-31-2023) PAGE 5
NRC FORM 313A (AUS) (07-31-2023) PAGE 6

I attest that 

Name of Proposed Authorized User

is able to independently fulfill the radiation safetyrelated duties as an authorized user for:

Remote afterloader unit(s) Teletherapy unit(s) Gamma stereotactic radiosurgery unit(s)

Complete one of the following for attestation and signature:

I meet the requirements in 10 CFR 35.490, 35.491, 35.690, or equivalent Agreement State requirements, as 

an authorized user for:

35.400 Manual brachytherapy sources

35.400 Ophthalmic use of strontium-90

35.600 Remote afterloader unit(s)

35.600 Teletherapy unit(s)

35.600 Gamma stereotactic radiosurgery unit(s)

Fourth Section

Fifth Section

NRC FORM 313A (AUS)

(07-31-2023)

U. S. NUCLEAR REGULATORY COMMISSION

AUTHORIZED USER TRAINING, EXPERIENCE AND PRECEPTOR ATTESTATION 

(for uses defined under 35.400 and 35.600) 

[10 CFR 35.57, 35.490, 35.491, and 35.690] (continued)

35.57 for 35.400 and/or 35.600 uses, as applicable

OR

Residency Program Director (for 35.490 and/or 35.690 only):

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 for:

35.400 Manual brachytherapy sources

35.600 Teletherapy unit(s)

35.600 Remote afterloader unit(s)

35.57 for 35.400 uses

35.57 for teletherapy unit(s)

35.57 for remote afterloader unit(s)

35.600 gamma stereotactic radiosurgery unit(s) 35.57 gamma stereotactic radiosurgery unit(s)

I affirm that this faculty member concurs with the attestation I am providing as program director.

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

Council on Postdoctoral Training of the American Osteopathic Association

Residency Review Committee of the Accreditation Council for Graduate Medical Education

Royal College of Physicians and Surgeons of Canada

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

35.490 35.690

Name of Facility:

License/Permit Number:

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

Signature

Telephone Number Date

Authorized User: