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Contact Information
First Name
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Organization Name
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Middle Initial
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Organization Email
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Last Name
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Organization Phone Number
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10-digit phone number without hyphens or parenthesis
Address
Organization Address 1
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Organization Address 2
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Organization City
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Organization State
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Alabama (AL)
Alaska (AK)
Alberta (AB)
American Samoa (AS)
Arizona (AZ)
Arkansas (AR)
British Columbia (BC)
California (CA)
Colorado (CO)
Connecticut (CT)
Delaware (DE)
District of Columbia (DC)
Florida (FL)
Georgia (GA)
Guam (GU)
Hawaii (HI)
Idaho (ID)
Illinois (IL)
Indiana (IN)
Iowa (IA)
Kansas (KS)
Kentucky (KY)
Louisiana (LA)
Maine (ME)
Manitoba (MB)
Maryland (MD)
Massachusetts (MA)
Michigan (MI)
Minnesota (MN)
Mississippi (MS)
Missouri (MO)
Montana (MT)
Nebraska (NE)
Nevada (NV)
New Brunswick (NB)
New Hampshire (NH)
New Jersey (NJ)
New Mexico (NM)
New York (NY)
Newfoundland and Labrador (NL)
North Carolina (NC)
North Dakota (ND)
Northern Mariana Islands (MP)
Northwest Territories (NT)
Nova Scotia (NS)
Nunavut (NU)
Ohio (OH)
Oklahoma (OK)
Ontario (ON)
Oregon (OR)
Pennsylvania (PA)
Prince Edward Island (PE)
Puerto Rico (PR)
Quebec (QC)
Rhode Island (RI)
Saskatchewan (SK)
South Carolina (SC)
South Dakota (SD)
Tennessee (TN)
Texas (TX)
U.S. Virgin Islands (VI)
Utah (UT)
Vermont (VT)
Virginia (VA)
Washington (WA)
West Virginia (WV)
Wisconsin (WI)
Wyoming (WY)
Yukon (YT)
Organization Zip Code
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5-digit zip code
Application Details
Do You Have an ICAM Account
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Do You Have an ICAM Account
No
Do You Have an ICAM Account
Yes
Applicant Type
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Applicant Type
New Applicant
Applicant Type
Existing Licensee
Applicant Type
Radioactive Materials Regulatory Agency
Applicant Type
Other Agency
Licensee Form Application
Licensee Form Application
No
Licensee Form Application
Yes
License Verification System (LVS)
License Verification System (LVS)
No
License Verification System (LVS)
Yes
National Source Tracking System (NSTS)
National Source Tracking System (NSTS)
No
National Source Tracking System (NSTS)
Yes
Web-Based Licensing (WBL)
Web-Based Licensing (WBL)
No
Web-Based Licensing (WBL)
Yes
Licenses Information
Agency
Alabama Department of Public Health (AL)
Arizona Radiation Regulatory Agency (AZ)
Arkansas Department of Health (AR)
California Department of Public Health (CA)
Colorado Department of Public Health & Environment (CO)
Connecticut Department of Energy & Environmental Protection (CT)
Florida Department of Health (FL)
Georgia Department of Natural Resources (GA)
Illinois Emergency Management Agency (IL)
Indiana Department of Homeland Security (IN)’
Iowa Department of Public Health (IA)
Kansas Department of Health and Environment (KS)
Kentucky Cabinet for Health and Family Services (KY)
Louisiana Department of Environmental Quality (LA)
Maine Department of Health and Human Services (ME)
Maryland Department of the Environment (MD)
Massachusetts Office of Health and Human Services (MA)
Minnesota Department of Health (MN)
Mississippi State Department of Health (MS)
Nebraska Department of Health & Human Services (NE)
Nevada Department of Health & Human Services (NV)
New Hampshire Department of Health & Human Services (NH)
New Jersey Department of Environmental Protection (NJ)
New Mexico Environment Department (NM)
New York City Department of Health (NYNYC)
New York State Department of Health (NYS)
North Carolina Dept. of Health and Human Resources (NC)
North Dakota Department of Environmental Quality (ND)
Ohio Department of Health (OH)
Oklahoma Department of Environmental Quality (OK)
Oregon Health Authority (OR)
Pennsylvania Department of Environmental Protection (PA)
Rhode Island Department of Health (RI)
South Carolina Department of Health and Environmental Control (SC)
Tennessee Department of Environment and Conservation (TN)
Texas Commission on Environmental Quality (TCEQ)
Texas Department of State Health Services (TX)
U.S. Customs and Border Protection (CBP)
U.S. Department of Commerce (DOC)
U.S. Department of Energy (DOE)
U.S. Department of Homeland Security (DHS)
U.S. Department of State (DOS)
U.S. Department of Transportation (DOT)
U.S. Federal Bureau of Investigation (FBI)
U.S. Nuclear Regulatory Commission (NRC)
Utah Department of Environmental Quality (UT)
Vermont Department of Health (VT)
Virginia Department of Health (VA)
Washington State Department of Health (WA)
Wisconsin Department of Health Services (WI)
License(s)
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Agency 2
Alabama Department of Public Health (AL)
Arizona Radiation Regulatory Agency (AZ)
Arkansas Department of Health (AR)
California Department of Public Health (CA)
Colorado Department of Public Health & Environment (CO)
Connecticut Department of Energy & Environmental Protection (CT)
Florida Department of Health (FL)
Georgia Department of Natural Resources (GA)
Illinois Emergency Management Agency (IL)
Indiana Department of Homeland Security (IN)’
Iowa Department of Public Health (IA)
Kansas Department of Health and Environment (KS)
Kentucky Cabinet for Health and Family Services (KY)
Louisiana Department of Environmental Quality (LA)
Maine Department of Health and Human Services (ME)
Maryland Department of the Environment (MD)
Massachusetts Office of Health and Human Services (MA)
Minnesota Department of Health (MN)
Mississippi State Department of Health (MS)
Nebraska Department of Health & Human Services (NE)
Nevada Department of Health & Human Services (NV)
New Hampshire Department of Health & Human Services (NH)
New Jersey Department of Environmental Protection (NJ)
New Mexico Environment Department (NM)
New York City Department of Health (NYNYC)
New York State Department of Health (NYS)
North Carolina Dept. of Health and Human Resources (NC)
North Dakota Department of Environmental Quality (ND)
Ohio Department of Health (OH)
Oklahoma Department of Environmental Quality (OK)
Oregon Health Authority (OR)
Pennsylvania Department of Environmental Protection (PA)
Rhode Island Department of Health (RI)
South Carolina Department of Health and Environmental Control (SC)
Tennessee Department of Environment and Conservation (TN)
Texas Commission on Environmental Quality (TCEQ)
Texas Department of State Health Services (TX)
U.S. Customs and Border Protection (CBP)
U.S. Department of Commerce (DOC)
U.S. Department of Energy (DOE)
U.S. Department of Homeland Security (DHS)
U.S. Department of State (DOS)
U.S. Department of Transportation (DOT)
U.S. Federal Bureau of Investigation (FBI)
U.S. Nuclear Regulatory Commission (NRC)
Utah Department of Environmental Quality (UT)
Vermont Department of Health (VT)
Virginia Department of Health (VA)
Washington State Department of Health (WA)
Wisconsin Department of Health Services (WI)
License(s)
*
Agency 3
Alabama Department of Public Health (AL)
Arizona Radiation Regulatory Agency (AZ)
Arkansas Department of Health (AR)
California Department of Public Health (CA)
Colorado Department of Public Health & Environment (CO)
Connecticut Department of Energy & Environmental Protection (CT)
Florida Department of Health (FL)
Georgia Department of Natural Resources (GA)
Illinois Emergency Management Agency (IL)
Indiana Department of Homeland Security (IN)’
Iowa Department of Public Health (IA)
Kansas Department of Health and Environment (KS)
Kentucky Cabinet for Health and Family Services (KY)
Louisiana Department of Environmental Quality (LA)
Maine Department of Health and Human Services (ME)
Maryland Department of the Environment (MD)
Massachusetts Office of Health and Human Services (MA)
Minnesota Department of Health (MN)
Mississippi State Department of Health (MS)
Nebraska Department of Health & Human Services (NE)
Nevada Department of Health & Human Services (NV)
New Hampshire Department of Health & Human Services (NH)
New Jersey Department of Environmental Protection (NJ)
New Mexico Environment Department (NM)
New York City Department of Health (NYNYC)
New York State Department of Health (NYS)
North Carolina Dept. of Health and Human Resources (NC)
North Dakota Department of Environmental Quality (ND)
Ohio Department of Health (OH)
Oklahoma Department of Environmental Quality (OK)
Oregon Health Authority (OR)
Pennsylvania Department of Environmental Protection (PA)
Rhode Island Department of Health (RI)
South Carolina Department of Health and Environmental Control (SC)
Tennessee Department of Environment and Conservation (TN)
Texas Commission on Environmental Quality (TCEQ)
Texas Department of State Health Services (TX)
U.S. Customs and Border Protection (CBP)
U.S. Department of Commerce (DOC)
U.S. Department of Energy (DOE)
U.S. Department of Homeland Security (DHS)
U.S. Department of State (DOS)
U.S. Department of Transportation (DOT)
U.S. Federal Bureau of Investigation (FBI)
U.S. Nuclear Regulatory Commission (NRC)
Utah Department of Environmental Quality (UT)
Vermont Department of Health (VT)
Virginia Department of Health (VA)
Washington State Department of Health (WA)
Wisconsin Department of Health Services (WI)
License(s)
*
Agency 4
Alabama Department of Public Health (AL)
Arizona Radiation Regulatory Agency (AZ)
Arkansas Department of Health (AR)
California Department of Public Health (CA)
Colorado Department of Public Health & Environment (CO)
Connecticut Department of Energy & Environmental Protection (CT)
Florida Department of Health (FL)
Georgia Department of Natural Resources (GA)
Illinois Emergency Management Agency (IL)
Indiana Department of Homeland Security (IN)’
Iowa Department of Public Health (IA)
Kansas Department of Health and Environment (KS)
Kentucky Cabinet for Health and Family Services (KY)
Louisiana Department of Environmental Quality (LA)
Maine Department of Health and Human Services (ME)
Maryland Department of the Environment (MD)
Massachusetts Office of Health and Human Services (MA)
Minnesota Department of Health (MN)
Mississippi State Department of Health (MS)
Nebraska Department of Health & Human Services (NE)
Nevada Department of Health & Human Services (NV)
New Hampshire Department of Health & Human Services (NH)
New Jersey Department of Environmental Protection (NJ)
New Mexico Environment Department (NM)
New York City Department of Health (NYNYC)
New York State Department of Health (NYS)
North Carolina Dept. of Health and Human Resources (NC)
North Dakota Department of Environmental Quality (ND)
Ohio Department of Health (OH)
Oklahoma Department of Environmental Quality (OK)
Oregon Health Authority (OR)
Pennsylvania Department of Environmental Protection (PA)
Rhode Island Department of Health (RI)
South Carolina Department of Health and Environmental Control (SC)
Tennessee Department of Environment and Conservation (TN)
Texas Commission on Environmental Quality (TCEQ)
Texas Department of State Health Services (TX)
U.S. Customs and Border Protection (CBP)
U.S. Department of Commerce (DOC)
U.S. Department of Energy (DOE)
U.S. Department of Homeland Security (DHS)
U.S. Department of State (DOS)
U.S. Department of Transportation (DOT)
U.S. Federal Bureau of Investigation (FBI)
U.S. Nuclear Regulatory Commission (NRC)
Utah Department of Environmental Quality (UT)
Vermont Department of Health (VT)
Virginia Department of Health (VA)
Washington State Department of Health (WA)
Wisconsin Department of Health Services (WI)
License(s)
*
Agency 5
Alabama Department of Public Health (AL)
Arizona Radiation Regulatory Agency (AZ)
Arkansas Department of Health (AR)
California Department of Public Health (CA)
Colorado Department of Public Health & Environment (CO)
Connecticut Department of Energy & Environmental Protection (CT)
Florida Department of Health (FL)
Georgia Department of Natural Resources (GA)
Illinois Emergency Management Agency (IL)
Indiana Department of Homeland Security (IN)’
Iowa Department of Public Health (IA)
Kansas Department of Health and Environment (KS)
Kentucky Cabinet for Health and Family Services (KY)
Louisiana Department of Environmental Quality (LA)
Maine Department of Health and Human Services (ME)
Maryland Department of the Environment (MD)
Massachusetts Office of Health and Human Services (MA)
Minnesota Department of Health (MN)
Mississippi State Department of Health (MS)
Nebraska Department of Health & Human Services (NE)
Nevada Department of Health & Human Services (NV)
New Hampshire Department of Health & Human Services (NH)
New Jersey Department of Environmental Protection (NJ)
New Mexico Environment Department (NM)
New York City Department of Health (NYNYC)
New York State Department of Health (NYS)
North Carolina Dept. of Health and Human Resources (NC)
North Dakota Department of Environmental Quality (ND)
Ohio Department of Health (OH)
Oklahoma Department of Environmental Quality (OK)
Oregon Health Authority (OR)
Pennsylvania Department of Environmental Protection (PA)
Rhode Island Department of Health (RI)
South Carolina Department of Health and Environmental Control (SC)
Tennessee Department of Environment and Conservation (TN)
Texas Commission on Environmental Quality (TCEQ)
Texas Department of State Health Services (TX)
U.S. Customs and Border Protection (CBP)
U.S. Department of Commerce (DOC)
U.S. Department of Energy (DOE)
U.S. Department of Homeland Security (DHS)
U.S. Department of State (DOS)
U.S. Department of Transportation (DOT)
U.S. Federal Bureau of Investigation (FBI)
U.S. Nuclear Regulatory Commission (NRC)
Utah Department of Environmental Quality (UT)
Vermont Department of Health (VT)
Virginia Department of Health (VA)
Washington State Department of Health (WA)
Wisconsin Department of Health Services (WI)
License(s)
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Notes
Requester Notes
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