NRC Form 5, Occupational Exposure Record for a Monitoring Period

Forms and Documents

Document Name	Status
Form NRC Form 5 NRC Form 5, Occupational Exposure Record for a Monitoring Period Form and Instruction	Modified
Final Supporting Statement - 2010.doc Supporting Statement A	2010-10-26

IC Document Collections

IC ID	Document Title	Status
33130	NRC Form 5, Occupational Exposure Record for a Monitoring Period Form and Instruction	Modified

ICR Details

OMB Control No: 3150-0006	ICR Reference No: 201006-3150-009
Status: Historical Active	Previous ICR Reference No: 200903-3150-002
Agency/Subagency: NRC	Agency Tracking No:
Title: NRC Form 5, Occupational Exposure Record for a Monitoring Period
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 06/07/2011
	Date Received in OIRA: 10/28/2010
Terms of Clearance: In accordance with 5 CFR 1320, the information collection is approved for 3 years. Upon resubmission, the agency should clarify which costs are related to personnel costs.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2014	36 Months From Approved	06/30/2011
Responses	4,042	0	173,419
Time Burden (Hours)	68,556	0	66,649
Cost Burden (Dollars)	0	0	0

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Abstract: NRC Form 5 is used to record and report the results of individual monitoring for occupational radiation exposure during a monitoring (one calendar year) period to ensure regulatory compliance with annual radiation dose limits specified in 10 CFR 20.1201.

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Authorizing Statute(s): PL: Pub.L. 83 - 703 1-311 Name of Law: Atomic Energy Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	75 FR 44816	07/29/2010
30-day Notice:	Federal Register Citation:	Citation Date:
	75 FR 66393	10/28/2010
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

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

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ICR Summary of Burden

	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	4,042	173,419	0	0	-169,377	0
Annual Time Burden (Hours)	68,556	66,649	0	0	1,907	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: The estimated burden has increased by 1,907 hours from the previous burden of 66,649 hours to 68,556 hours (61,766 hours recordkeeping + 6,790 hours reporting). This burden change is due to an increase in the number of monitored individuals at licensee facilities pursuant to 10 CFR 20.1501. The increase in the number of monitored individuals increases the number of records received by the NRC. In the previous clearance, NRC received 173,419 records. As of June 2008, NRC received 187,170 records (184,155 electronic records + 3,015 paper records). However, the professional cost per hour has increased from $217/hr. to $257/hr. In addition, the number of responses has decreased from 173,419 to 4,042. This change is due to the correction to the calculation of these responses. In the previous clearance period, each record that was kept by a recordkeeper was counted as a response. Therefore, the number of responses was calculated as: the number of reporting responses plus the total number of records kept. In the current clearance, the calculation of responses has been corrected. Each recordkeeper has been counted as a single response, regardless of the number of records kept. Therefore, the number of responses is equal to the number of reporting responses plus the number of recordkeepers.

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Annual Cost to Federal Government: $547,924

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 10/28/2010

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