NRC Form 5, Occupational Exposure Record for a Monitoring Period

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3150-0006 can be found here:

Documents and Forms

Document Name Document Type
Form NRC Form 5 NRC Form 5, Occupational Exposure Record for a Monitoring Period Form and Instruction
NRC Form 5 Occupational Dose Record For A Monitoring Period nrc5.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	NRC Form 5, Occupational Exposure Record for a Monitoring Period	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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 and Instruction	NRC Form 5	Occupational Dose Record For A Monitoring Period	nrc5.pdf		Yes	Yes	Fillable Printable

Line of Business: Energy

Subfunction: Energy Resource Management

Privacy Act System of Records
Title: NRC-27	FR Citation: 69 FR 57601

Number of Respondents: 4,212	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 47 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	173,419	1,000	172,419
Annual IC Time Burden (Hours)	66,649	1,031	65,618
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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.