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NRC Form 396, Certification of Medical Examination by Facility Licensee
NRC Form 396, Certification of Medical Examination by Facility Licensee
OMB: 3150-0024
IC ID: 33230
OMB.report
NRC
OMB 3150-0024
ICR 200511-3150-002
IC 33230
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3150-0024 can be found here:
2023-03-20 - No material or nonsubstantive change to a currently approved collection
2022-06-01 - Extension without change of a currently approved collection
Documents and Forms
Document Name
Document Type
no available documents/forms check other ICs listed under this ICR
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
NRC Form 396, Certification of Medical Examination by Facility Licensee
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Migrated
Obligation to Respond:
Mandatory
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form
396
Yes
Yes
Federal Enterprise Architecture Business Reference Module
Line of Business:
Subfunction:
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
137
Number of Respondents for Small Entity:
0
Affected Public:
Private Sector
Private Sector:
Businesses or other for-profits
Percentage of Respondents Reporting Electronically:
5 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
1,287
0
0
47
0
1,240
Annual IC Time Burden (Hours)
758
0
0
7
0
751
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.