NRC Form 5, Occupational Exposure Record for a Monitoring Period

ICR 200708-3150-002

OMB: 3150-0006

Federal Form Document

Forms and Documents
Document
Name
Status
Form and Instruction
Modified
Supporting Statement A
2007-08-02
IC Document Collections
ICR Details
3150-0006 200708-3150-002
Historical Active 200408-3150-003
NRC
NRC Form 5, Occupational Exposure Record for a Monitoring Period
Revision of a currently approved collection   No
Regular
Approved without change 11/30/2007
Retrieve Notice of Action (NOA) 08/15/2007
  Inventory as of this Action Requested Previously Approved
11/30/2010 36 Months From Approved 11/30/2007
172,419 0 175,456
65,618 0 67,460
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 dose limits.

PL: Pub.L. 83 - 703 68 STAT 919 Name of Law: Atomic Energy Act
  
None

Not associated with rulemaking

  72 FR 25787 05/07/2007
72 FR 43665 08/06/2007
No

1
IC Title Form No. Form Name
NRC Form 5, Occupational Exposure Record for a Monitoring Period NRC Form 5 Occupational Dose Record For A Monitoring Period

  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 172,419 175,456 0 0 -3,037 0
Annual Time Burden (Hours) 65,618 67,460 0 0 -1,842 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$478,485
No
No
Uncollected
Uncollected
Uncollected
Uncollected
Carl Feldman 301 415-6194 [email protected]

  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.
08/15/2007


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