NRC Form 748 National Source Tracking Transaction Report, Short Form

Submit by Email
U.S. NUCLEAR REGULATORY COMMISSION APPROVED BY OMB: NO. 3150-0202

NRC FORM 748
(6-2010)
10 CFR 20.2207

NATIONAL SOURCE TRACKING TRANSACTION REPORT

EXPIRES: 12/31/2012

Estimated burden per response to comply with this mandatory information collection request: 9.5 minutes. NRC requires this information to
populate the National Source Tracking System for certain sealed sources. Send comments regarding burden estimate to the Records and
FOIA/Privacy Services Branch (T-5 F53), 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, (3150-0202), Office o f
Management and Budget, Washington, DC 20503. If a means used to impose an information collection does not display a currently vaild
OMB control number, the NRC may not conduct or sponsor, and a person is not required to respond to, the information collection.

1. LICENSEE INFORMATION
A. LICENSEE NAME

C. LICENSEE STREET ADDRESS1

B. LICENSE NO.

2. TRANSACTION DATE

3A. TRANSACTION INFORMATION

(Only transactions completed on the same
date may be reported together on this form)

NEW

CORRECTION

IF CORRECTION, PREVIOUS TRANSACTION DATE:

E. STATE F. ZIP CODE

D. CITY

3B. TRANSACTION TYPE (Check only "New Source Manufactured)
REPORT SOURCE
INVENTORY

TRANSFER

IMPORT

RECEIPT

NEW SOURCE
MANUFACTURED

DISPOSAL

EXPORT

DISASSEMBLE

4. PREPARER INFORMATION
A. NAME OF PREPARER

B.DATE PREPARED

D. PREPARER E-MAIL REQUIRED FOR CONFIRMATION

C. PREPARER PHONE

9. NEW MANUFACTURED SOURCE DATA
A1. SOURCE MAKE

G1 SOURCE LOCATION ADDRESS

B1. SOURCE MODEL

H1. CITY

C1. SOURCE SERIAL D1. ISOTOPE
NUMBER

I1. STATE

E1. ACTIVITY AND UNIT

J1. ZIP CODE

F1. COMMENTS

K1. SAME AS
STREET ADDRESS

WARNING: FALSE STATEMENTS IN THIS CERTIFICATE MAY BE SUBJECT TO CIVIL AND/OR CRIMINAL PENALTIES. NRC REGULATIONS REQUIRE THAT SUBMISSIONS
TO THE NRC BE COMPLETE AND ACCURATE IN ALL MATERIAL RESPECTS. 18 U.S.C. SECTION 1001 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.
NRC FORM 748 (6-2010)

NRC FORM 748
(6-2010)
10 CFR 20.2207

U.S. NUCLEAR REGULATORY COMMISSION

LICENSEE NAME

LICENSE NO.

NATIONAL SOURCE TRACKING
TRANSACTION REPORT (continued)
9. NEW MANUFACTURED SOURCE DATA

A2. SOURCE MAKE

G2 SOURCE LOCATION ADDRESS

A3. SOURCE MAKE

G3 SOURCE LOCATION ADDRESS

A4. SOURCE MAKE

G4 SOURCE LOCATION ADDRESS

A5. SOURCE MAKE

G5 SOURCE LOCATION ADDRESS

B2. SOURCE MODEL

H2. CITY

B3. SOURCE MODEL

H3. CITY

B4. SOURCE MODEL

H4. CITY

B5. SOURCE MODEL

I5. CITY

C2. SOURCE SERIAL D2. ISOTOPE
NUMBER

I2. STATE

E2. ACTIVITY AND UNIT

J2. ZIP CODE

C3. SOURCE SERIAL D3. ISOTOPE
NUMBER

I3. STATE

I4. STATE

C5. SOURCE SERIAL D5. ISOTOPE
NUMBER

J5. STATE

K2. SAME AS
STREET ADDRESS

E3. ACTIVITY AND UNIT

J3. ZIP CODE

C4. SOURCE SERIAL D4. ISOTOPE
NUMBER

F2. COMMENTS

F3. COMMENTS

K3 SAME AS
STREET ADDRESS

E4. ACTIVITY AND UNIT

J4. ZIP CODE

F4. COMMENTS

K4. SAME AS
STREETADDRESS

E5. ACTIVITY AND UNIT

K5. ZIP CODE

F5. COMMENTS

L5. SAME AS
STREET ADDRESS

WARNING: FALSE STATEMENTS IN THIS CERTIFICATE MAY BE SUBJECT TO CIVIL AND/OR CRIMINAL PENALTIES. NRC REGULATIONS REQUIRE THAT SUBMISSIONS
TO THE NRC BE COMPLETE AND ACCURATE IN ALL MATERIAL RESPECTS. 18 U.S.C. SECTION 1001 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.
NRC FORM 748 (6-2010)

INSTRUCTIONS TO NRC AND AGREEMENT STATE LICENSEES FOR REPORTING HIGH-RISK SEALED SOURCE TRANSACTIONS
The completed form is considered to be Official Use Only – Security Related Information; it is not considered to be Safeguards Information. Use an addendum sheet
for reporting additional sources.

Source Receipt Data – For Receipt transaction reports, all fields in Section 7 are
required EXCEPT M. Waste Manifest Number, N. Container ID, and T. Comments. If
the licensee is reporting multiple sources on the Receipt transaction at the same
Source Location Address, the location address information may be populated once,
and referenced in the Comments block for the additional sources.
8. Source Disposal Data – For Disposal transaction reports, all fields in Section 8 are
required EXCEPT J. Comments. If the licensee is reporting multiple sources on the
Disposal transaction at the same Source Disposal Address, the source disposal
address information may be populated once, and referenced in the Comments block
for the additional sources.
9. New Manufactured Source Data – For New Manufactured Source transaction
reports, all fields in Section 9 are required EXCEPT F. Comments. If the licensee is
reporting multiple sources on the Manufacturer transaction at the same Source
Location Address, the location address information may be populated once, and
referenced in the Comments block for the additional sources.
10. Source Import Data – For Import Source transaction reports, all fields are required
EXCEPT L. Comments. If the licensee is reporting multiple sources on the Import
transaction at the same Source Location Address, the location address information
may be populated once, and referenced in the Comments block for the additional
sources.
11. Source Export Data – For Export Source transaction reports, all fields are required
EXCEPT M. Comments. If the licensee is reporting multiple sources on the Export
transaction to the same Foreign Company/Foreign Address, the information in cells
A-E may be populated once, and referenced in the Comments block for the
additional sources.
12. Source Disassemble Data – For Disassemble Source transaction reports, all fields
are required EXCEPT H. Comments. If the licensee is reporting multiple sources on
the Disassemble transaction at the same Source Location Address, the location
address information may be populated once, and referenced in the Comments block
for the additional sources.
7.

1.
2.
3.

4.

5.

6.

Note to Licensees: This form may be used to report source transactions in lieu of
using the NSTS online application. Sections 1-4 on Page 1 of the form are required
for all source transaction types. Sections 5 – 12 should only be populated for the
associated Transaction Type (3B) selected. For example, when reporting a Source
Transfer and a Source Export, Sections 6 and 11 should be populated. Multiple
Transaction Types may be selected if they occur on the same Transaction Date, and
should be reported on NRC Form 748. Licensees reporting only one transaction type
may use the condensed form for the Transaction Type. For example, when reporting
a Source Receipt, NRC Form 748c should be used.
Licensee Information – Enter the name and license number, and street address of
the licensed facility
Transaction Date – Enter the date the transaction occurred, which would be the date
of the transfer, receipt, manufacture, etc.
Transaction Information and Transaction Type – Indicate if this is a new transaction
or a correction. For corrections, select the date of the previously submitted
transaction that the correction should be associated with. Select the Transaction
Type. Report Source should only be used for initial inventory submissions, or to
report a source excluded from the initial inventory submission. Dispose Source
should only be used by a Disposal Licensee. If you are sending your source back to
the manufacturer, or sending it to a disposal facility, the transaction should be
recorded as a Transfer. Multiple Transaction Types may be selected if they occur on
the same Transaction Date.
Preparer Information – An email address is required for a confirmation. For
regulatory purposes, your source transaction report is not considered complete
without a confirmation from the NSTS Help Desk that the transaction report has
been received.
Source Inventory Data – This section should only be used for initial inventory
submissions. The Make, Model and Serial Number refer to the Source, not the
Device. All fields are required in Section 5 EXCEPT G. Comments. If the licensee is
reporting multiple sources on the Source Inventory transaction at the same Source
Location Address, the location address information may be populated once, and
referenced in the Comments block for the additional sources.
Source Transfer Data – For Transfer transaction reports, all fields in Section 6 are
required EXCEPT M. Waste Manifest Number, N. Container ID, and P. Comments. If
the licensee is reporting multiple sources on the Transfer transaction to the same
Receiving Licensee, the receiving licensee information may be populated once, and
referenced in the Comments block for the additional sources.

DISTRIBUTION
Mail one copy to: Lockheed Martin, NSTS Help Desk, 30 West
Gude Drive, Suite 300, Rockville, MD, 20850
or FAX a copy to: (240) 403-4391
or Submit by email: [email protected] or by clicking the
“Submit by Email” button at the top of the form.