NRC Form 5, Occupational Exposure Record for a Monitoring Period

ICR 200408-3150-003

OMB: 3150-0006

Federal Form Document

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Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
ICR Details
3150-0006 200408-3150-003
Historical Active 200107-3150-006
NRC
NRC Form 5, Occupational Exposure Record for a Monitoring Period
Revision of a currently approved collection   No
Regular
Approved without change 09/16/2004
Retrieve Notice of Action (NOA) 08/13/2004
  Inventory as of this Action Requested Previously Approved
09/30/2007 09/30/2007 10/31/2004
175,456 0 370,212
67,460 0 66,682
0 0 0

NRC Form 5 is used to record and report the results of individual monitoring for occupational radiation exposure during a one-year (calendar year) period to ensure regulatory compliance with annual radiation does limits.

None
None


No

1
IC Title Form No. Form Name
NRC Form 5, Occupational Exposure Record for a Monitoring Period NRC-FORM-5

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 175,456 370,212 0 0 -194,756 0
Annual Time Burden (Hours) 67,460 66,682 0 0 778 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
08/13/2004


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