Policy Statements, Criteria for Guidance of States and NRC in Discontinuance of NRC Regulatory Authority and Assumption thereof by states through agreement and IMPEP Questionnaire.

Approved by OMB1
No. 3150-0183
Expires 08/31/2010
INTEGRATED MATERIALS PERFORMANCE EVALUATION PROGRAM
QUESTIONNAIRE
Name of State/Regional Program
Reporting Period: Month XX, [YEAR], to Month XX, [YEAR]
Note: If there has been no change in the response to a specific question since the last IMPEP
questionnaire, the State or Region may copy the previous answer, if appropriate.
A.

GENERAL
1.

Please prepare a summary of the status of the State's or Region's actions taken
in response to each of the comments and open recommendations following the
last from previous IMPEP reviews.

B.

COMMON PERFORMANCE INDICATORS

I.

Technical Staffing and Training
2.

3.

1

Please provide the following organization charts, including names and positions:
(a)

A chart showing positions from the Governor down to the Radiation
Control Program Director;

(b)

A chart showing positions of current the radiation control program,
including management; and

(c)

Equivalent charts for sealed source and device evaluation, low-level
radioactive waste and uranium recovery programs, if applicable.

Please provide a staffing plan, or complete a listing using the suggested format
below, of the professional (technical) full-time equivalents (FTE) applied to the
radioactive materials program by individual. Include the name, position, and, for
Agreement States, the fraction of time spent in the following areas:
administration, materials licensing & compliance, emergency response, low-level
radioactive waste, uranium recovery, other. If these regulatory responsibilities
are divided between offices, the table should be consolidated to include all
personnel contributing to the radioactive materials program. Include all
vacancies and identify all senior personnel assigned to monitor work of junior

Estimated burden per response to comply with this voluntary collection request: 53 hours. Forward comments
regarding burden estimate to the Records Management Branch (T-5 F52), U.S. Nuclear Regulatory Commission,
Washington, DC 20555-0001, and to the Paperwork Reduction Project (3150-0183), Office of Management and
Budget, Washington, DC 20503. If an information collection does not display a currently valid OMB control number,
NRC may not conduct or sponsor, and a person is not required to respond to, the information collection.

personnel. If consultants were used to carry out the program's radioactive
materials responsibilities, include their efforts. The table heading should be:
Name

II.

Position

Area of Effort

FTE%

4.

Please provide a listing of all new professional personnel hired into your
radioactive materials program since the last review, indicate the date of hire; the
degree(s) they received, if applicable,; and additional training; and years of
experience in health physics, or other disciplines, as appropriate.

5.

Please list all professional staff who have not yet met the qualification
requirements for a radioactive materials license reviewer or materials inspector.
For each, list the courses or equivalent training/experience they need and a
tentative schedule for completion of these requirements.

6.

Identify any changes to your qualification and training procedure that occurred
during the review period.

7.

Please identify the technical staff that left your radioactive materials program
during the review period and indicate the date they left.

8.

List any vacant positions in your radioactive materials program, the length of time
each position has been vacant, and a brief summary of efforts to fill the vacancy.

9.

For Agreement States, does your program have an oversight board or committee
which provides direction to the program and is composed of licensees and/or
members of the public? If so, please describe the procedures used to avoid any
potential conflict of interest.

Status of Materials Inspection Program
10.

Please identify individual licensees or categories of licensees the State is
inspecting less frequently than called for in NRC’s Inspection Manual Chapter
(IMC) 2800 and explain the reason for the difference. The list only needs to
include the following information: license category or licensee name, and license
number, your inspection interval, and rationale for the difference.

11.

Please provide the number of routine inspections of Priority 1, 2, and 3 licensees,
as defined in IMC 2800;, and the number of initial inspections; and the number of
increased controls inspections that were completed during each year of the
review period.

12.

Please submit a table, or a computer printout, that identifies inspections of
Priority 1, 2, and 3 licensees, increased controls, and initial inspections that were
conducted overdue per the applicable guidance. Priority 1, 2, and 3 licensees
and initial inspections must be conducted at least as frequently as the inspection
intervals established in IMC 2800. Increased controls inspections should be
conducted at the intervals established in the Staff Requirements Memorandum
for COMSECY-05-0028.

At a minimum, the list should include the following information for each inspection
that was conducted overdue during the review period:
(1) Licensee Name
(2) License Number
(3) Priority (IMC 2800)
(4) Last inspection date or license issuance date, if initial inspection
(5) Date Due
(6) Date Performed
(7) Amount of Time Overdue
(8) Date inspection findings issued

III.

13.

Please submit a table or computer printout that identifies any Priority 1, 2, and 3
licensees, increased controls, and initial inspections that are currently overdue,
per the applicable guidanceIMC 2800. At a minimum, the list should include the
same information for each overdue inspection provided for Question 12 plus your
action plan for completing the inspection. Also include your plan for completing
the overdue inspections.

14.

Please provide the number of reciprocity licensees that were candidates for
inspection per year as described in IMC 1220 and indicate the number of
candidate licensee reciprocity inspections of candidate licensees that were
completed each year during the review period.

Technical Quality of Inspections
15.

What, if any, changes were made to your written inspection procedures during
the reporting period?

16.

Prepare a table showing the number and types of supervisory accompaniments
made during the review period. Include:
Inspector

17.

IV.

Supervisor

License Category

Date

Describe or provide an update on your instrumentation, methods of calibration,
and laboratory capabilities. Are all instruments properly calibrated at the present
time? Were there sufficient calibrated instruments available throughout the
review period?

Technical Quality of Licensing Actions
18.

How many specific radioactive material licenses does the Pyour program
regulate at this time?

19.

Please identify any major, unusual, or complex licenses which were issued,
received a major amendment, were terminated, decommissioned, submitted a
bankruptcy notification or renewed in this period.

V.

20.

Identify any licensees or groups of licensees that were issued increased controls
during the review period. Those licensees that were initially identified during the
initial implementation of increased controls need not be listed.

210.

Discuss any variances in licensing policies and procedures or exemptions from
the regulations granted during the review period.

221.

What, if any, changes were made in your written licensing procedures (new
procedures, updates, policy memoranda, etc.) during the reporting period?

232.

Identify by licensee name and license number any renewal applications that have
been pending for one year or more. Please indicate why these reviews have
been delayed and describe your action plan to reduce the backlog.

Technical Quality of Incident and Allegation Activities
243.

For Agreement States, please provide a list of any reportable incidents not
previously submitted to NRC (See Procedure SA-300, Reporting Material Events,
for additional guidance, OMB clearance number 3150-0178). The list should be
in the following format:
Licensee Name

License #

Date of Incident/Report

Type of
Incident

25.

During this review period, did any incidents occur that involved equipment or
source failure or approved operating procedures that were deficient? If so, how
and when were other State/NRC licensees who might be affected notified? For
States, was timely notification made to NRC? For Regions, was an appropriate
and timely PN generated? For Agreement States, was information on the incident
provided to the agency responsible for evaluation of the device for an
assessment of possible generic design deficiency? Please provide details for
each case.

264.

Identify any changes to your procedures for responding to incidents and
allegations that occurred during the period of this review.

C.

NON-COMMON PERFORMANCE INDICATORS

I.

Compatibility Requirements
275.

Please list all currently effective legislation that affects the radiation control
program. Denote any legislation that was enacted or amended during the review
period.

286.

Are your regulations subject to a "Sunset" or equivalent law? If so, explain and
include the next expiration date for your regulations.

297.

Please review and verify that the information in the enclosed State Regulation
Status (SRS) sheet is correct. For those regulations that have not been adopted

by the State, explain why they were not adopted, and discuss actions being
taken to adopt them. If legally binding requirements were used in lieu of
regulations and they have not been reviewed by NRC for compatibility, please
describe their use.
3028. If you have not adopted all amendments within three years from the date of NRC
rule promulgation, briefly describe your State's procedures for amending
regulations in order to maintain compatibility with the NRC, showing the normal
length of time anticipated to complete each step.
II.

Sealed Source and Device (SS&D) Evaluation Program
3129. Prepare a table listing new and amended (including transfers to inactive status)
SS&D registrations of sources and devices issued during the review period. The
table heading should be:
SS&D
Registry
Number
320.

Manufacturer,
Distributor or
Custom User

Product Type
or Use

Date
Issued

Type of
Action

Please include information on the following questions in Section A, as they apply
to the SS&D Program:
Technical Staffing and Training - Questions 2-9
Technical Quality of Licensing Actions - Questions 18-232
Technical Quality of Incident and Allegation Activities - Questions 243-264

III.

Low-Llevel Radioactive Waste Disposal Program
331.

Please include information on the following questions in Section A, as they apply
to the Low-Level Radioactive Waste Disposal Program:
Technical Staffing and Training - Questions 2-9
Status of Materials Inspection Program - Questions 10-14
Technical Quality of Inspections - Questions 15-17
Technical Quality of Licensing Actions - Questions 18-232
Technical Quality of Incident and Allegation Activities - Questions 243-264

IV.

Uranium Recovery Program
342.

Please include information on the following questions in Section A, as they apply
to the Uranium Recovery Program:
Technical Staffing and Training - Questions 2-9
Status of Materials Inspection Program - Questions 10-14
Technical Quality of Inspections - Questions 15-17
Technical Quality of Licensing Actions - Questions 18-232
Technical Quality of Incident and Allegation Activities - Questions 243-264

MATERIALS REQUESTED TO BE AVAILABLE FOR
THE ON-SITE PORTION OF AN IMPEP REVIEW
Please have the following information available for use by the IMPEP review team when
they arrive at your office:
□
□
□
□
□
□
□
□
□

List of open license cases, with date of original request, and dates of followup
actions.
List of licenses terminated during review period.
Copy of current log or other document used to track licensing actions.
List of all licensing actions completed during the review period (sorted by license
reviewer, if possible).
Copy of current log or other document used to track inspections.
List of all inspections completed during the review period (sorted by inspector, if
possible).
List of inspection frequencies by license type.
List of all allegations occurring during the review period. Show whether the
allegation is open or closed and whether it was referred by NRC.
List of all licenses that your agency has imposed additional security requirements
upon.

ALSO, PLEASE HAVE THE FOLLOWING DOCUMENTS AVAILABLE:
□

All State regulations

□

Documented training plan, if applicable

□

Statutes affecting the regulatory authority

□

Records of results of supervisory

of the State program

accompaniments of inspectors

□

Standard license conditions

□

Emergency plan and communications list

□

Technical procedures for licensing,

□

Procedures for investigating allegations

model licenses, review guides

□

Procedures for investigating incidents

SS&D review procedures, guides, and

□

Enforcement procedures, including

□

standards

procedures for escalated enforcement,

□

Instrument calibration records

severity levels, civil penalties (as

□

Inspection procedures and guides

applicable)

□

Inspection report forms

□

Job descriptions