N-91 IAEA Form N-91- Information in Respect of Nuclear Materi

INFORMATION IN RESPECT OF NUCLEAR
MATERIAL OUTSIDE FACILITIES*
APPROVED BY OMB: NO. 3150-0056

CONFIDENTIAL
WHEN COMPLETED

DATE:
EXPIRES: 08/31/2011

Estimated burden per response to comply with this mandatory collection
request: 180 hours. NRC is required to collect this information for reporting to
IAEA from facility licensees appearing on the U.S. Eligible List. 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,
(3150-0056), 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.

INTERNATIONAL ATOMIC ENERGY AGENCY
DEPARTMENT OF SAFEGUARDS AND INSPECTION

DESIGN INFORMATION
QUESTIONNAIRE *
(CONTINUED)
The "Confidential" marking on this form is for IAEA
purposes only. It indicates that the IAEA considers
the information in the completed form to be
'safeguards confidential' and is not to be confused
with any U.S. security classification.

IAEA USE ONLY

* Questions which are not applicable may be left
unanswered.

INFORMATION IN RESPECT OF NUCLEAR MATERIAL OUTSIDE FACILITIES*
GENERAL INFORMATION
1. LOCATION AND POSTAL ADDRESS FOR
ROUTINE BUSINESS PURPOSES

2. OWNER
(legally responsible)

N-91 (8-2008)

CONFIDENTIAL

* Locations where the amount of nuclear material is less than one effective kilog ram
(for each separate location, attach separate sheet).

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INFORMATION IN RESPECT OF NUCLEAR
MATERIAL OUTSIDE FACILITIES

DATE:

GENERAL INFORMATION
3. OPERATOR
(legal responsible)

4. NAMES AND/OR TITLES AND ADDRESS
OF RESPONSIBLE OFFICERS
(for nuclear material accountancy and
control and contact with the Agency)

NUCLEAR MATERIAL DESCRIPTION AND FLOW
5. TYPE OF NUCLEAR MATERIAL

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INFORMATION IN RESPECT OF NUCLEAR
MATERIAL OUTSIDE FACILITIES

DATE:

NUCLEAR MATERIAL DESCRIPTION AND FLOW
6. GENERAL MATERIAL DESCRIPTION
(for each type)
i)

Chemical and Physical Form

ii)

Enrichment Range and Pu Content

iii)

Amounts of Nuclear Material Usually
Kept at the Location

7. MEANS OF NUCLEAR MATERIAL
IDENTIFICATION

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INFORMATION IN RESPECT OF NUCLEAR
MATERIAL OUTSIDE FACILITIES

DATE:

NUCLEAR MATERIAL DESCRIPTION AND FLOW
8. RADIATION LEVEL
(at the surface of the nuclear material,
at a distance of 1 metre)

9. DESCRIPTION OF MAIN CONTAINERS
USED FOR STORAGE AND HANDLING

IF NECESSARY, ATTACH DRAWING(S)

10. NUCLEAR MATERIAL TRANSFER
EQUIPMENT

IF NECESSARY, ATTACH DRAWING(S)

11. IDENTIFICATION OF MEASUREMENT
POINTS, ACCOUNTABILITY AREAS,
INVENTORY LOCATION

FLOW SHEET(S) ATTACHED UNDER REFERENCE NUMBERS:

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INFORMATION IN RESPECT OF NUCLEAR
MATERIAL OUTSIDE FACILITIES

DATE:

PROTECTION AND SAFETY MEASURES
12. BASIC MEASURES FOR PHYSICAL
PROTECTION OF NUCLEAR MATERIAL

13. SPECIFIC HEALTH AND SAFETY RULES
FOR INSPECTOR COMPLIANCE

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INFORMATION IN RESPECT OF NUCLEAR
MATERIAL OUTSIDE FACILITIES

DATE:

NUCLEAR MATERIAL ACCOUNTANCY AND CONTROL
14. DESCRIPTION OF THE SYSTEM

SPECIMEN FORMS USED IN ALL PROCEDURES ATTACHED
UNDER REFERENCE NUMBERS:

Give description of:
-- the nuclear material accountancy
-- system
the method of recording and reporting
accountancy data and establishing
-- material balance
the procedures for account adjustment
after inventory, etc.
under the following headings:
i) General

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INFORMATION IN RESPECT OF NUCLEAR
MATERIAL OUTSIDE FACILITIES

DATE:

NUCLEAR MATERIAL ACCOUNTANCY AND CONTROL
14. DESCRIPTION OF THE SYSTEM
(Continued)
ii)

Receipts

iii)

Shipments

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INFORMATION IN RESPECT OF NUCLEAR
MATERIAL OUTSIDE FACILITIES

DATE:

NUCLEAR MATERIAL ACCOUNTANCY AND CONTROL
14. DESCRIPTION OF THE SYSTEM
(Continued)
iv)

Measured Discards and
Retained Waste

v)

Physical Inventory
Description of procedures, scheduled
frequency, method of operator's
inventory taking, expected accuracy,
access to nuclear material

vi)

Operational Records and
Accounting Records
(including method adjustment or
correction and place of preservation
and language)

N-91 (8-2008)

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INFORMATION IN RESPECT OF NUCLEAR
MATERIAL OUTSIDE FACILITIES

DATE:

NUCLEAR MATERIAL ACCOUNTANCY AND CONTROL
15. FOR EACH MEASUREMENT POINT OF
ACCOUNTABILITY AREAS, IDENTIFIED
UNDER QS. 11, GIVE THE FOLLOWING
(if applicable)
i)

Description of Location, Type,
Identification

ii)

Physical and Chemical form of
Nuclear Material
(with cladding materials description)

iii)

Measurement Method(s) and
Equipment Used

iv)

Method of Converting Source Data
to Batch Data

N-91 (8-2008)

SEPARATE SHEET(S) CAN BE ATTACHED FOR EACH
MEASUREMENT POINT. IF NECESSARY, ATTACH DRAWING(S)

CONFIDENTIAL

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INFORMATION IN RESPECT OF NUCLEAR
MATERIAL OUTSIDE FACILITIES

DATE:

NUCLEAR MATERIAL ACCOUNTANCY AND CONTROL
15. FOR EACH MEASUREMENT POINT OF
ACCOUNTABILITY AREAS, IDENTIFIED
UNDER QS. 11, GIVE THE FOLLOWING
(if applicable)
(Continued)
v)

Means of Batch Identification and
Batch Data Description

OPTIONAL INFORMATION
16. OPTIONAL INFORMATION
(that the operator considers relevant to
safeguarding the nuclear material)

Signature of Responsible Officer:

Date:

N-91 (8-2008)

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