ARRA-4X - Arizona Radiation Regulatory Agency - azrra 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the Facility Name, Street Address, City, and Zip Code in the designated fields.
3. If you are a current registrant, input your Registration Number. Otherwise, leave this field blank.
4. Fill in the Date of application and provide Your Name and Title in the respective fields.
5. Select the Machine Type by checking the applicable box for your diagnostic x-ray equipment.
6. Indicate whether you are a NEW Applicant and specify the Machine Subtype as either Stationary, Mobile, Portable, Handheld, or Transportable.
7. Provide Equipment Information including Manufacturer name, Number of tubes, Model Name, and Location of unit.
8. Answer whether this unit replaces a registered X-ray unit in your facility by selecting YES or NO. If YES, provide additional details as required.
9. For SHIELDING INFORMATION, attach a scale drawing of your facility and include necessary calculations for compliance with AZ Administrative Code.
10. Finally, review all entries for accuracy before signing at the bottom of the form.

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