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Forms

GENERAL AGENCY FORMS

  • Services Registration Application (ARRA-SRA)
  • Physicist Support Application - Physics Support in variety of modalities (does not add to license or registration)
  • NVLAP Approved Dosimetry Services
  • Radiation Safety Consultants - Registered Physics Support
  • ARRA Complaint Form
  • Request for Public Documents - Commercial Use
  • Request for Public Documents - Non-Commercial Use

NONIONIZING APPLICATIONS

  • Non-Ionizing Facility Registration (ARRA-NIR)- Nonionizing Radiation Facility
  • Non-Ionizing Machine Information (ARRA-NIMI) - Make and Model name of each Bed, Laser, RF, etc.
  • Medical Director/Prescribing Official Attestation/ApplicationPrescribing Authority ONLY
  • Health Professional Training Application/AttestationRegistered Nurses and Physician's Assistants (RN's & PA's)
  • Medical Director Acknowledgement (Non-Cosmetic) form for Medical Facilities (Hospitals, Medical Offices, Veterinary Offices, Podiatric, and Dental Offices) 
  • Medical Director Acknowledgement (Chiro) Medical Director Acknowledgement/liability for Chiropratic Offices
  • Cosmetic Facility Medical Director Acknowledgement form for IPL/Laser Hair Removal and Cosmetic Facilities
  • LSO Acknowledgement Statement form for Laser Safety Officers
  • RF Acknowledgment Form Acknowledgment form for individuals in charge of RadioFrequency Safety
  • Nonionizing Annual and Registration Fee Schedule

LASER TECHNICIAN FORMS

  • New Laser Technician Application
  • Laser Technician Renewal Application
  • Affidavit of Practice - Cosmetic Laser Tech
  • Affidavit of Non Practice - Cosmetic Laser Tech
  • CLT Duplicate Certificate Request Form
  • New Cosmetic Training School Application and Renewal- Application for Didactic and Hands-on Training Schools
  • Supervising Laser Technician (SLT) 24 hr Approval letter
  • Supervising Prescribing Health Professional 24 hr approval letter (Medical Director)
  • Supervising Health Professional 24 hr approval letter 

MRTBE FORMS

  • MRTBE application for all 
  • MRTBE-CT-Preceptorship Training Application 
  • PTR Acknowledgment - Scope of Practice for PTR, PTP, PTBD
  • MRTBE Blank Renewal Form
  • Mammography Student Form 
  • Radiologist Assistant Application 
  • AccuBoost Positioning Verification form 
  • Affidavit of Practice 
  • Affidavit of non Practice 
  • MRTBE Complaint form
  • Application for Boards and Commissions- Application to serve as a MRTBE Board Member

X-RAY APPLICATIONS

  • X-Ray Facility Application (ARRA-4) - Application for Registration of X-Ray Facility
  • X-Ray Annual and Registration Fee Schedule X-Ray unit (by Tube and intended use)
  • Industrial Unit Information (ARRA-4I) - Supplimental for Industrial or Medical specimen unit
  • Medical Unit Information (ARRA-4X) - Supplimental for Medical/Dental/Veterinary 
  • Mammography Screening Application (ARRA-13)- Supplimental Application for Screening Approval
  • E-Brachytherapy Supplimental Application (ARRA-ET) - Therapy Supplemental Form

RAM APPLICATIONS

  • Industrial/Medical Specific Materials License (ARRA-1G)
  • Legal Structure Cover Application (AZRRA-LSRAM) for the Radioactive Materials Program
  • Laboratory-Industrial License Application (ARRA-L)
  • Small Entity form
  • Authorized Medical Physicist Preceptor
  • Authorized Nuclear Pharmacist Preceptor 
  • Authorized User Preceptor(100,200,& 500) 
  • Authorized User Preceptor(300) 
  • Authorized User Preceptor(400 & 600)
  • Radiation Safety Officer Preceptor (ARRA-2) 
  • Depleted Uranium Application (ARRA-23)
  • Fixed Gauge Application (ARRA-FG)
  • Industrial Radiography Application (ARRA-IR)
  • Medical Application (ARRA-M)
  • Medical Event Reporting Form (ARRA-ME)
  • Particle Accelerator Application (ARRA-PA)
  • Portable Gauge Application (ARRA-1PG)
  • Reciprocity Application (ARRA-REC)
  • Radiation Safety Officer (Delegation of Authority) 
  • Registration Certificate Gauging Device with Radioactive Material Under General License (ARRA-17)

* All forms/applications are in Adobe PDF format. Click icon to get Adobe Acrobat Reader. 

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  • News
  • Rules
    • ARRA Policies
    • Large and Small Business Regulatory Bill of Rights (Notice of Audit)
  • Calendar
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  • FY 2019 Agency Budget Plan
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Contact Arizona Radiation Regulatory Agency
Arizona Radiation Regulatory Agency
4814 S. 40th St.
Phoenix, AZ 85040
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Phone: (602) 255-4845
Fax: (602) 437-0705
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