Zz113 120 2025

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The document is a registration application for users of radiation machines in Texas, specifically for facilities in healing arts, dental, veterinary medicine, and medical academic settings. It outlines the necessary information required for registration, including facility details, types of radiation machines used, and the responsibilities of the Radiation Safety Officer (RSO). The application must be completed fully and submitted to the Texas Department of State Health Services along with appropriate fees. It also includes privacy notifications regarding personal information collected by the state.

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Click ‘Get Form’ to open the zz113 120 application in the editor.
Begin by entering the legal name of your facility as registered with the Texas Secretary of State. If applicable, include your Doing Business As (DBA) name.
Fill in your mailing address, ensuring to include street address, city, state, and zip code.
Provide the physical location details of your facility, including county information.
Enter the facility site phone number and fax number for communication purposes.
Designate a Radiation Safety Officer (RSO) and attach their qualifications as required. Include their contact information.
Select the type of action you are applying for by checking all relevant boxes. Specify the total number of x-ray machines used at your location.
If mobile services are utilized, indicate the provider's name and registration number along with machine category details.
Complete all signature fields at the end of the form to certify that all information is accurate and true.

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