Form NRC Form 7 NRC Form 7 Application for NRC Export/Import License, Amendment, or

Page 1 of
U.S. NUCLEAR REGULATORY COMMISSION APPROVED BY OMB: NO. 3150-0027

NRC FORM 7

EXPIRES: 06/30/2009

Estimated burden per response to comply with this mandatory collection request: 2.4 hours. This
submittal is reviewed to ensure that the applicable statutory, regulatory, and policy considerations
are satisfied. Send comments regarding burden estimate to the Records and FOIA/Privacy
Services Branch (T-5 F52), U.S. Nuclear Regulatory Commission, Washington, DC 20555-0001,
or by internet e-mail to [email protected], and to the Desk Officer, Office of Information and
Regulatory Affairs, NEOB-10202, (3150-0027), Office of Management and Budget, Washington,
DC 20503. If a means used to impose an information collection does not display a currently valid
OMB control number, the NRC may not conduct or sponsor, and a person is not required to
respond to, the information collection.

(8-2007)
10 CFR 110

APPLICATION FOR NRC EXPORT/IMPORT
LICENSE, AMENDMENT, OR RENEWAL
(See Instructions on Page 5)

DATE RECEIVED

PART A. FOR NRC USE ONLY
LICENSE NUMBER

PUBLIC

OR

NON-PUBLIC

DOCKET NUMBER

ADAMS ACCESSION NUMBER

PART B. TO BE COMPLETED FOR ALL LICENSES, AMENDMENTS, RENEWALS OR NOTIFICATIONS
(If more space is needed to complete any of the items, use Pages 3-4 first, and then attach additional sheets, if necessary.)
1. NAME AND ADDRESS OF APPLICANT/LICENSEE

1a. NAME OF APPLICANT'S CONTACT

1b. APPLICANT'S REFERENCE NUMBER

1c. PHONE NUMBER

1d. FAX NUMBER

1e. E-MAIL ADDRESS

2. TYPE OF ACTION REQUESTED (Check One)
NOTIFICATION OF
EXPORT
EXPORT OF
(Parts B, C, E)
INCIDENTAL
RADIOACTIVE
MATERIAL (PART C, E)
3. CONTRACT NUMBER(S)

IMPORT
(Parts B, D, E)

4. FIRST SHIPMENT DATE

COMBINED EXPORT/IMPORT
(Parts B, C, D, E)

5. LAST SHIPMENT DATE

AMENDMENT/RENEWAL
Existing License Number:

6. PROPOSED EXPIRATION DATE

PART C. TO BE COMPLETED FOR EXPORT ONLY OR COMBINED LICENSES, AMENDMENTS, OR RENEWALS
(If more space is needed to complete any of the items, use Pages 3-4 first, and then attach additional sheets, if necessary.)
7. NAME(S) / ADDRESS(ES) OF SUPPLIERS
AND/OR OTHER PARTIES TO THE EXPORT

8. NAME(S) / ADDRESS(ES) OF INTERMEDIATE
FOREIGN CONSIGNEE(S)

9. NAME(S) / ADDRESS(ES) OF ULTIMATE
FOREIGN CONSIGNEE(S)

7a. FUNCTION(S) PERFORMED/SERVICE(S) PROVIDED

8a. INTERMEDIATE USE(S)

9a. ULTIMATE END USE(S)

10. DESCRIPTION OF RADIOACTIVE MATERIALS, SEALED SOURCES,
NUCLEAR FACILITIES, EQUIPMENT, OR COMPONENTS; FOR
NUCLEAR EQUIPMENT INCLUDE TOTAL DOLLAR VALUE OF
EQUIPMENT FOR EXPORT

10a. MAX TOTAL VOLUME /
ELEMENT WGT (KG), OR
TOTAL ACTIVITY (TBq)

10b. MAX ENRICHMENT
OR WGT %

10c. MAX ISOTOPE
WGT (KG)

11. FOREIGN OBLIGATIONS (BY COUNTRY AND BY PERCENTAGE OF MAXIMUM TOTAL VOLUME)

NRC FORM 7 (8-2007)

PRINTED ON RECYCLED PAPER

Page 2 of
NRC FORM 7

U.S. NUCLEAR REGULATORY COMMISSION

(8-2007)
10 CFR 110

APPLICATION FOR NRC EXPORT/IMPORT
LICENSE, AMENDMENT, OR RENEWAL (Continued)
LICENSE NUMBER

DOCKET NUMBER

ADAMS ACCESSION NUMBER

PUBLIC

OR

NON-PUBLIC

PART D. TO BE COMPLETED FOR IMPORT ONLY, OR COMBINED LICENSES, AMENDMENTS, OR RENEWALS
(If more space is needed to complete any of the items, use Pages 3-4 first, and then attach additional sheets, if necessary.)
12. NAME(S) / ADDRESS(ES) OF FOREIGN
SUPPLIERS AND/OR OTHER PARTIES
TO IMPORT

13. NAME(S) / ADDRESS(ES) OF INTERMEDIATE
CONSIGNEE(S)

14. NAME(S) / ADDRESS(ES) OF ULTIMATE
CONSIGNEE(S)

12a. NRC EXPORT LICENSE NUMBER(S)
(if applicable)

13a. LICENSE NUMBER(S) / EXPIRATION DATE(S)

14a. LICENSE NUMBER(S) / EXPIRATION DATE(S)

13b. INTERMEDIATE USE(S)

14b. ULTIMATE END USE(S)

15. DESCRIPTION OF RADIOACTIVE MATERIALS, SEALED SOURCES,
NUCLEAR FACILITIES

15a. MAX TOTAL VOLUME /
ELEMENT WGT (KG), OR
TOTAL ACTIVITY (TBq)

15b. MAX ENRICHMENT
OR WGT %

15c. MAX ISOTOPE
WGT (KG)

16. FOREIGN OBLIGATIONS (BY COUNTRY AND BY PERCENTAGE OF MAXIMUM TOTAL VOLUME)

PART E. TO BE COMPLETED FOR ALL LICENSES, AMENDMENTS, OR RENEWALS
17. ADDITIONAL INFORMATION
PROVIDED ON PAGES 3, 4,
AND/OR ON SEPARATE SHEETS?

18. CERTIFICATION:

YES

NO

17a. COPIES OF RECIPIENTS'
AUTHORIZATIONS PROVIDED?

YES

NO

I, the applicant's authorized official, hereby certify that this application is prepared in conformity with Title10,
Code of Federal Regulations, and that all information provided is correct to th e best of my knowledge.

18a. PRINT NAME AND TITLE OF AUTHORIZED OFFICIAL

18b. SIGNATURE -- AUTHORIZED OFFICIAL

18c. DATE

Page
NRC FORM 7

of

U.S. NUCLEAR REGULATORY COMMISSION

(8-2007)
10 CFR 110

APPLICATION FOR NRC EXPORT/IMPORT
LICENSE, AMENDMENT, OR RENEWAL (Continued)
LICENSE NUMBER

DOCKET NUMBER

ADAMS ACCESSION NUMBER

PUBLIC
ADDITIONAL INFORMATION (Reference applicable block numbers from page 1 and/or page 2 for each entry)

OR

NON-PUBLIC

U.S. NUCLEAR REGULATORY COMMISSION
INSTRUCTIONS FOR PREPARATION OF NRC FORM 7, APPLICATION FOR
NRC EXPORT/IMPORT LICENSE, AMENDMENT OR RENEWAL
General Instructions: A completed, signed original NRC Form 7 may be mailed to the Deputy Director, Office of International
Programs, U.S. Nuclear Regulatory Commission, Washington, DC 20555-0001, or hand-delivered to the Deputy Director at 11555
Rockville Pike, Rockville, Maryland 20852.
Refer to Title 10 of the Code of Federal Regulations, Part 110, for specific NRC export/import licensing requirements. For each
license, amendment or renewal application, identify all foreign and domestic locations where exports or imports will be handled,
sorted, repackaged and/or processed in any way. Provide information on quantities, forms, and other characteristics of the
radioactive materials, sealed sources, nuclear facilities and equipment to be exported or imported and indicate how they will be
used by each of the parties listed. If more space is needed to complete any of the items on this form, use the continuation pages
first, and then attach additional sheets. Reference appropriate BLOCK number(s) for each entry on all additional sheets. All
applicants should avoid submitting proprietary information unless absolutely necessary, as NRC is required to make copies of all
applications received available to the public. If proprietary information must be submitted, follow procedures in 10 CFR 2.390,
otherwise, such information could be publicly disclosed and/or processing of an application could be significantly delayed.
PART A. FOR NRC USE ONLY
PART B. TO BE COMPLETED BY ALL APPLICANTS
BLOCK 1. Enter name and complete physical address of the
corporation or other entity with direct control over distribution
of proposed export(s) or import(s), and where required
records will be maintained and can be inspected. Post Office
Box Numbers or names of divisions or departments within a
legal entity are NOT acceptable entries for this BLOCK.
BLOCKS 1a-e. Provide name and contact information
identifying the best party to answer questions about an
application. Applicants should use BLOCK 1b to assign their
own reference number to identify application documents.
BLOCK 2. Indicate the TYPE OF NRC LICENSING ACTION
requested by checking:
- EXPORT if applying for a new export license.
- IMPORT if applying for a new import license.
- COMBINED EXPORT/IMPORT if applying for a new license
to export one or more radioactive materials listed in 10 CFR
110, Appendix P, which will need to allow for the return of one
or more of these materials to appropriate U.S. recipients.
- AMENDMENT/RENEWAL if applying to modify or extend an
export, import or combined license previously issued by NRC
(and not yet expired), include NRC license number in space
provided. If NRC receives an amendment/ renewal
application at least 30 days or more before the license
expires, its terms will remain valid and, if circumstances
permit, it can continue to be used until NRC completes action
on the amendment/ renewal application.
- EXPORT OF INCIDENTAL RADIOACTIVE MATERIAL to
report using a general license as authority to export incidental
radioactive material.
BLOCK 3. If known, provide contract number(s), which may
be useful references for example, if reviewers need to contact
recipients or other parties listed on the application.
BLOCK 4. Enter the anticipated date of the first shipment
(MM/DD/YYYY).
BLOCK 5. Enter the anticipated date of last shipment
(MM/DD/YYYY).
BLOCK 6. Enter a proposed license expiration date
(MM/DD/YYYY), to accommodate export activities. Note that
NRC licenses are typically issued for 1-5 years.

NOTE: For amendments and renewals, provide only the new
or changed information, as appropriate, in PART C and/or
PART D. (For example, enter names and addresses of
parties or consignees, only if they need to be added to,
deleted from, or their information needs to be changed. If
seeking to increase the volume or quantity of material or
equipment, specify the additional increment, and, if
applicable, indicate what the new, combined cumulative total
will be.)
PART C. TO BE COMPLETED BY APPLICANTS FOR
EXPORT OR COMBINED LICENSES, AMENDMENTS OR
RENEWALS
BLOCK 7. Enter names of supplier(s) and other parties to
export not listed in BLOCKS 1, 8, OR 9. Provide complete
physical address(es) where correspondence should be sent
and where export(s) can be inspected. Post Office Box
Numbers are NOT acceptable entries for this BLOCK.
BLOCK 7a. Describe functions to be performed and/or
services to be provided by any parties listed in BLOCK 7.
BLOCKS 8-9. Enter names and physical address(es) for each
intermediate and each ultimate foreign location. Post Office
Box Numbers are NOT acceptable entries for these BLOCKS.
BLOCKS 8a and 9a. Describe how each consignee will use
export(s), including functions to be performed and/or services
to be provided.
BLOCK 10. Describe key characteristics including physical
and chemical forms, etc., of radioactive materials (i.e.,
source, special nuclear or byproduct materials including
sealed sources or devices and radioactive waste), nuclear
facilities and equipment. Identify source material as natural or
depleted uranium, or thorium, and provide chemical form
(e.g., U3O8, Th-227). Identify and provide total volume in
kilograms of ores containing 0.05% or more of source
material (e.g., tantalum, niobium) and specify source material
contained. Identify special nuclear material as plutonium,
high enriched uranium (> 20% U-235) or low enriched
uranium (<20% U-235) and specify chemical form.
Identify Appendix L byproduct materials by name and form,
including maximum total quantities and types of sealed
sources and/or devices to be exported over the license life.
Identify Appendix P materials by name and form, including
maximum total quantities and types of sealed sources and/or
devices to be exported on a per shipment basis. For
radioactive waste, identify and provide maximum total volume

in kilograms for each non-radioactive material involved, and
physical and chemical forms for each radioactive
material, along with the overall waste classification (see 10
CFR 61.55); route(s) of transit, forms of management and
ultimate disposition. For nuclear facilities, provide total
quantity; types; names, design power or annual capacity
rating; and the estimated combined total dollar value. For
nuclear equipment, identify all items by name, total quantity
and function and provide the estimated combined total dollar
value.
BLOCK 10a. For source material, provide maximum total
volume/element weight over license life in kilograms. For
special nuclear material, provide maximum total element
weight over license life in kilograms. For each Appendix L
byproduct material listed, provide maximum total activity over
license life in Terabequerels (TBq). For each Appendix P
material listed, provide maximum total activity per shipment in
Tbq.
BLOCKS 10b-c. For special nuclear material including as
radioactive waste, provide maximum weight % (enrichment)
and total isotope weight over license life in kilograms.
BLOCK 11. Identify each country and the percentage of the
maximum total volume that may be obligated to them
(requires U.S. Government action, e.g., prior notification).
PART D. TO BE COMPLETED BY APPLICANTS FOR
IMPORT OR COMBINED LICENSES, AMENDMENTS OR
RENEWALS
BLOCK 12. Enter name(s) and address(es) of foreign
supplier(s) or exporter(s).
BLOCK 12a. For import(s) originally exported under a specific
NRC license, enter that license number.
BLOCKS 13 and 14. Complete if applicant in BLOCK 1 is not
the sole intermediate or sole ultimate recipient. Provide
complete physical mailing address(es) where
correspondence should be sent and import(s) could be
inspected. Post Office Box Numbers are NOT acceptable
entries for this block.
BLOCKS 13a and 14a. Enter NRC or Agreement State
Materials License number(s) including expiration date(s)
(MM/DD/YYYY) for each U.S. consignee, authorizing receipt,
possession, use or distribution.
BLOCKS 13b and 14b. Describe how each consignee listed
will use proposed import(s), including functions to be
performed and/or services to be provided.

BLOCK 15. Describe key characteristics including physical
and chemical forms, etc., of radioactive materials (i.e.,
source, special nuclear or byproduct materials including
sealed sources or devices and radioactive waste), and
nuclear facilities. For radioactive waste, identify and provide
maximum total volume in kilograms for each non-radioactive
material (e.g., contaminated steel) involved, and physical and
chemical forms for each radioactive source, special nuclear
or byproduct material. Provide overall waste classification
(see 10 CFR 61.55); responsible industrial process, route(s)
of transit, and the status of arrangements for disposition in
the U.S., e.g., any agreement by a low-level waste compact
or State to accept for management or disposal. For Appendix
P materials, identify by name and form, including maximum
total quantities of any bulk materials and/or the maximum
total quantities and types of sealed sources and/or devices
per shipment. For nuclear facilities, provide total quantities;
types; names, design power or annual capacity rating; and
the estimated combined total dollar value.
BLOCK 15a. For source and/or special nuclear material,
including that which is in the form of radioactive waste,
provide maximum total volume/element weight over license
life in kilograms. For Appendix L byproduct material,
including that which is in the form of radioactive waste,
provide maximum total activity over license life in TBq. For
Appendix P radioactive materials, provide maximum total
activity per shipment in Tbq for each material whether in bulk
form or in a sealed source or device.
BLOCKS 15b-c. For special nuclear material including that
which is in the form of radioactive waste, provide maximum
enrichment/weight % and maximum total isotope weight over
license life in kilograms.
BLOCK 16. Identify each country and the percentage of the
maximum total volume that may be obligated to them (require
U.S. Government action, e.g., prior notification).
PART E. TO BE COMPLETED BY ALL APPLICANTS
BLOCK 17. Check YES or NO to verify whether or not
additional information is being provided using the space
provided on the continuation pages and separate sheets.
BLOCK 17a. Check YES or NO to verify whether or not
copies of domestic recipients' authorizations required for
Appendix P materials (see Part 110.32 requirements) are
included with the application.
BLOCKS 18a-c. An authorized official of the legal entity
applying for the License, Amendment or Renewal, must
certify the information provided, by signing the document,
providing his/her title and the date of the application
(MM/DD/YYYY).