Are you a North Carolina resident preparing to do your taxes? Getting everything in order and filing on time can be tricky for anyone, but luckily there is an online form that can make the process much easier. Form Rs 11 from the North Carolina Department of Revenue ensures taxpayers get accurate information and comply with state tax laws. Through this blog post, we will explain what Form Rs 11 is meant to do, who must file it and how it benefits taxpayers year-round. Read on for more information about this important document before filing your taxes!
| Question | Answer |
|---|---|
| Form Name | North Carolina Form Rs 11 |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | rs11 filling online pregnancy forms |
RS 11
NORTH CAROLINA STATE UNIVERSITY
ENVIRONMENTAL HEALTH AND PUBLIC SAFETY
RADIATION SAFETY DIVISION
PREGNANCY DECLARATION, INSTRUCTION & DOSIMETRY EVALUATION
SECTION 1 – VOLUNTARY PREGNANCY STATEMENT
I, ______________________________, voluntarily declare my pregnancy to North Carolina State
University Radiation Safety Division, as stated in North Carolina Regulations for the Protection Against Radiation, 15A NCAC 11. The estimated date of conception for this pregnancy is
______________ __________.
(Month) (Year)
_________________________________________________ |
NCSU ID#: ________________________ |
Department/ Principal Investigator |
(nine digits) |
_________________________________________________ |
|
Campus Box Number/Campus Telephone Number |
|
|
|
SECTION 2 – INSTRUCTION TO EMPLOYEE |
|
Oral and written information about prenatal occupational radiation exposure has been provided to the individual declaring pregnancy at this time. This information includes:
1.The risk associated with prenatal radiation exposure and methods available for minimizing risk.
2.A review of previous personnel monitoring results for the individual, if available.
3.The fetal dose limit of 0.5 rem during the gestation period for occupationally exposed declared pregnant workers.
4.The U.S. NRC Regulatory Guide 8.13 Instructions Concerning Prenatal Radiation Exposure.
5.An opportunity to ask questions and receive answers concerning the information provided.
[Fetal dose limits and time period information are taken from 15 NCAC 11. 1609, .1610, .1614 and the Radiation Safety Manual]
SECTION 3 – DOSIMETRY EVALUATION*
Additional fetal dosimetry devices are available for those individuals likely to receive fetal doses in excess of 10% of the established fetal dose limit, as proscribed in the 15 NCAC 11.1609, .1610, .1614. The utilization and application of such devices has been discussed with the individual declaring pregnancy at this time.
|
|
Yes |
No |
1. |
Fetal dosimetry devices offered? |
||
2. |
Fetal dosimetry devices accepted? |
*Note: Fetal dosimetry service is issued for the duration of the declared pregnancy.
SECTION 4 – ACKNOWLEDGMENTS
I acknowledge that the above information relating to occupational exposure to radiation has been discussed and an opportunity to ask questions was available.
Declarer: ___________________________________________ |
Date: ________________ |
Radiation Safety Officer:_______________________________ |
Date: ________________ |
Radiation Safety Manual, Version VI, 2005