DOE/NRC-F-741 US Department of Energy and US Nuclear Regulatory Commis

U.S. DEPARTMENT OF ENERGY AND U.S. NUCLEAR REGULATORY COMMISSION

DOE/NRC F 741
(09-98) Previous editions are obsolete.
MANDATORY DATA COLLECTION
AUTHORIZED BY 10 CFR 30, 40, 50, 70,
75, 150. Public Laws 83-703, 93-438, 95-91

1. SHIPPERS RIS (1-4)

OMB Control No.
1910-1800

NUCLEAR MATERIAL TRANSACTION REPORT
Public reporting burden for this collection of information is estimated to average 30 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering
and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information,
including suggestions for reducing this burden, to Information, Records, and Resource Management, HR-41 - GTN, Paperwork Reduction Project (1910-1800), U.S. Department of Energy,
1000 Independence Avenue, S.W., Washington, DC 20585; and to the Office Management and Budget (OMB), Paperwork Reduction Project (1910-1800), Washington, DC 20503.

2. RECEIVERS RIS (5-8)

3. TRANSACTION NO (9-14)

4. CORRECTION NO (15)

5. PROCESSING CODE (16)
SHIPPER

6. RESERVED (17)

7. ACTION CODE (18)

RECEIVER

SHIPPER

8. DATA CODE (19)

DOCUMENTATION (Only if document is classified SECRET)

RECEIVER

PAGE

OF

PAGES

COPY

OF
NO.

9. A. NAME AND ADDRESS
OF SHIPPER

B. LICENSE NO.

10. A. NAME AND ADDRESS
OF RECEIVER

B. LICENSE NO.

11. NO. OF DATA LINES 1(20-21)

12. NATURE OF TRANSACTION 1(22)

13. A. SHIPPED FOR ACCOUNT OF

B. RIS 1(23-26)

COPIES, SERIES
DISTRIBUTION OF COPIES

1

14. A. SHIPPED TO ACCOUNT OF

B. RIS 1(27-30)

2
3
4

C. ATTENTION

C. ATTENTION

D. TELEPHONE

D. TELEPHONE

5
6
16. EXPORT OR IMPORT TRANSFERS: A. LICENSE NO. 3(22-31)

15. TRANSFER AUTHORITY-CONTRACT, NM DRAFT, OR ORDER NUMBER 1 (34-50)

7

B. U.S. PORT EXIT/ENTRY 3(32-35)
17. MATERIAL TYPE AND DESCRIPTION

8

18. TRANSPORTATION PROFILE
A. TRIP
SEG.

21. MISCELLANEOUS

B. CONCISE NOTE
ATTACHED
C. CONCISE NOTE
ATTACHED

19. PACKAGE IDENTIFICATION

B. CARRIER
IDENTIFICATION

C. TRANSFER POINT

A. MODEL ID.

NO. OF
ITEMS

PROJECT
NUMBER

2(24-39)
C

2(40-43)
D

2(44-53)
E

MATE
RIAL
TYPE

COMP/
FACILITY
CODE

2(54-55)
F

2(56-59)
G

PROD.
CODE

2(60)
H

OWNER
CODE

2(61)
I

MONTH
(1(70-71)

1

3(36-39)

3(40-44)

4(22-25)

4(26-28)

A. SHIPMENT

2

3(45-48)

3(49-53)

4(29-32)

4(33-35)

B. SHIPPER'S CORRECTION

YES

NO

3

3(54-57)

3(58-62)

4(36-39)

4(40-42)

C. RECEIPT

YES

NO

4

3(63-66)

3(67-71)

4(43-46)

4(47-49)

D. RECEIVER'S MEASUREMENT

5

3(72-75)

4(50-53)

4(54-56)

E. RECEIVERS CORRECTION

COUNTRY CONTROL
NUMBER

2(62-69)
J

KEY
MEAS.
POINT
2(70-71)
K

MEAS. IDENT.
L
1
BASIS
2(72)

24. SHIPPER'S DATA

T. SIGNATURE OF AUTHORIZED OFFICIAL AND DATE SIGNED

DAY
1(72-73)

YEAR
1(74-77)

23. TOTAL VOLUME (Waste Transfers Only) 4(67-75)

GROSS WEIGHT

NET WEIGHT

ELEMENT WEIGHT

ELEMENT
LIMIT OF
ERROR

WEIGHT %
ISOTOPE

ISOTOPE WEIGHT

ISOTOPE
LIMIT OF
ERROR

M

N

5(43-53)
O

5(54-58)
P

5(59-64)
Q

5(65-75)
R

5(76-80)
S

2
3
OMP METHOD
2(73-74)
2(75)

24. SHIPPER'S DATA

IDENTIFICATION
(BATCH NAME)

9

B. NUMBER

22. TOTAL GROSS WEIGHT 4(57-66)

LINE
TYPE
NO.
OF INV.
2/5
CHANGE
(20-21) 2(22-23)
A
B

20. ACTION DATE

25. RECEIVER'S DATA

T. SIGNATURE OF AUTHORIZED OFFICIAL AND DATE SIGNED
(See instructions for provisions regarding confidentiality)

25. RECEIVER'S DATA

(See instructions for provisions regarding confidentiality)

18 U.S.C. SECTION 1001; ACT OF JUNE 25, 1948; 62 STAT. 749; MAKES IT A CRIMINAL OFFENSE TO MAKE A WILLFULLY FALSE STATEMENT
OR REPRESENTATION TO ANY DEPARTMENT OR AGENCY OF THE UNITED STATES AS TO ANY MATTER WITHIN ITS JURISDICTION.
Printed with soy ink on recycled paper

OMB Control No.
1910-1800

DOE/NRC F 741
(07-97) Previous editions are obsolete.
MANDATORY DATA COLLECTION
AUTHORIZED BY 10 CFR 30, 40, 50, 70,
75, 150. Public Laws 83-703, 93-438, 95-91

OMB BURDEN DISCLOSURE STATEMENT

Public reporting burden for this collection of information is estimated to average 30 minutes per response, including the time for reviewing instructions, searching
existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this
burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to Information, Records, and Resource
Management, HR-41 - GTN, Paperwork Reduction Project (1910-1800), U.S. Department of Energy, 1000 Independence Avenue, S.W., Washington, DC 20585;
and to the Office Management and Budget (OMB), Paperwork Reduction Project (1910-1800), Washington, DC 20503.