Information Collection

NRC Form 664 (3150-0198 Agreement State Licensees)

IC 44877 under ICR 200607-3150-006 · OMB 3150-0233.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form NRC Form 664 NRC Form 664 (3150-0198 Agreement State Licensees)	Form and Instruction
NRC Form 664 General Licensee Registration nrc664.pdf www.nrc.gov/reading-rm/doc-collections/forms/nrc664.pdf	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Mandatory

CFR Citation: 10 CFR 31.5

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	NRC Form 664	General Licensee Registration	nrc664.pdf	http://www.nrc.gov/reading-rm/doc-collections/forms/nrc664.pdf	No		Fillable Fileable

Line of Business: Health

Subfunction:

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 12

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Program Change Due to New Statute
Annual Number of Responses for this IC	12	12
Annual IC Time Burden (Hours)	4	4
Annual IC Cost Burden (Dollars)	788	788

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.