DA Form 3337 Application for Army Radiation Authorization

DA Form 3337 or the "Application For Army Radiation Authorization" is a Department of the Army-issued form used by and within the United States Military.

The form - often incorrectly referred to as the DD form 3337 - was last revised on September 1, 2011. Download an up-to-date fillable DA Form 3337 down below in PDF-format or look it up on the Army Publishing Directorate website.

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APPLICATION FOR ARMY RADIATION AUTHORIZATION
For use of this form, see DA Pamphlet 385-24; the proponent agency is DAS.
1. THIS IS AN APPLICATION FOR (Check appropriate item)
2. NAME, MAILING ADDRESS, AND E-MAIL ADDRESS OF APPLICANT
(Include ZIP Code)
NEW ARA
AMENDMENT TO ARA NUMBER
RENEWAL OF ARA NUMBER
3. ADDRESSES WHERE AUTHORIZED IONIZING RADIATION SOURCES WILL BE USED OR POSSESSED
4. NAME OF PERSON TO BE CONTACTED ABOUT THIS APPLICATION
5. TELEPHONE NUMBER AND FAX NUMBER
Items 6 through 12 may be continued on the following page or on 8 1/2 x 11 inch paper. The type and scope of
information to be provided should be adequate to show complete compliance with applicable regulations and
guidance. (If you can link use of radioactive material to a valid Nuclear Regulatory Commission (NRC) license,
provide number and expiration date of the license and only submit items that differ from the NRC license
application and associated documents.)
6. RADIATION SOURCE(s)
a. RADIOACTIVE MATERIAL (Element and mass number, chemical
b. ACCELERATOR(s) AND X-RAY SYSTEM(s) CAPABLE OF
PRODUCING A "HIGH RADIATION AREA" OR "VERY HIGH RADIATION
and/or physical form, and maximum amount that you will possess at
any one time.)
AREA" (Describe)
7. PURPOSE(s) FOR WHICH IONIZING RADIATION SOURCE(s) WILL
8. INDIVIDUAL(s) RESPONSIBLE FOR RADIATION SAFETY PROGRAM
BE USED
AND THEIR TRAINING AND EXPERIENCE
9. TRAINING FOR INDIVIDUALS WORKING IN OR FREQUENTING
10. FACILITIES AND EQUIPMENT (Describe rooms or areas, sheidling,
RESTRICTED AREAS
safety devices, monitoring equipment, and so on.)
11. RADIATION SAFETY PROGRAM
12. WASTE MANAGEMENT
13. CERTIFICATION
The applicant understands that all statements and representations made in this application are binding upon the applicant.
The applicant and any official executing this certification on behalf of the applicant, named in Item 2, certify that all
information contained in this application is true and correct to the best of their knowledge and belief.
14. NAME, RANK, AND TITLE OF CERTIFYING OFFICER
15. SIGNATURE
16. DATE (YYYYMMDD)
Page 1 of 2
PREVIOUS EDITIONS ARE OBSOLETE.
DA FORM 3337, SEP 2011
APD LC v1.00ES
APPLICATION FOR ARMY RADIATION AUTHORIZATION
For use of this form, see DA Pamphlet 385-24; the proponent agency is DAS.
1. THIS IS AN APPLICATION FOR (Check appropriate item)
2. NAME, MAILING ADDRESS, AND E-MAIL ADDRESS OF APPLICANT
(Include ZIP Code)
NEW ARA
AMENDMENT TO ARA NUMBER
RENEWAL OF ARA NUMBER
3. ADDRESSES WHERE AUTHORIZED IONIZING RADIATION SOURCES WILL BE USED OR POSSESSED
4. NAME OF PERSON TO BE CONTACTED ABOUT THIS APPLICATION
5. TELEPHONE NUMBER AND FAX NUMBER
Items 6 through 12 may be continued on the following page or on 8 1/2 x 11 inch paper. The type and scope of
information to be provided should be adequate to show complete compliance with applicable regulations and
guidance. (If you can link use of radioactive material to a valid Nuclear Regulatory Commission (NRC) license,
provide number and expiration date of the license and only submit items that differ from the NRC license
application and associated documents.)
6. RADIATION SOURCE(s)
a. RADIOACTIVE MATERIAL (Element and mass number, chemical
b. ACCELERATOR(s) AND X-RAY SYSTEM(s) CAPABLE OF
PRODUCING A "HIGH RADIATION AREA" OR "VERY HIGH RADIATION
and/or physical form, and maximum amount that you will possess at
any one time.)
AREA" (Describe)
7. PURPOSE(s) FOR WHICH IONIZING RADIATION SOURCE(s) WILL
8. INDIVIDUAL(s) RESPONSIBLE FOR RADIATION SAFETY PROGRAM
BE USED
AND THEIR TRAINING AND EXPERIENCE
9. TRAINING FOR INDIVIDUALS WORKING IN OR FREQUENTING
10. FACILITIES AND EQUIPMENT (Describe rooms or areas, sheidling,
RESTRICTED AREAS
safety devices, monitoring equipment, and so on.)
11. RADIATION SAFETY PROGRAM
12. WASTE MANAGEMENT
13. CERTIFICATION
The applicant understands that all statements and representations made in this application are binding upon the applicant.
The applicant and any official executing this certification on behalf of the applicant, named in Item 2, certify that all
information contained in this application is true and correct to the best of their knowledge and belief.
14. NAME, RANK, AND TITLE OF CERTIFYING OFFICER
15. SIGNATURE
16. DATE (YYYYMMDD)
Page 1 of 2
PREVIOUS EDITIONS ARE OBSOLETE.
DA FORM 3337, SEP 2011
APD LC v1.00ES
ITEMS 6 THRU 12 (Continued)
Page 2 of 2
DA FORM 3337, SEP 2011
APD LC v1.00ES

Download DA Form 3337 Application for Army Radiation Authorization

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