NRC Form 396, Certification of Medical Examination by Facility Licensee

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form NRC Form 396 NRC Form 396, Certification of Medical Examination by Facility Licensee	Form and Instruction	Modified	Available
Final Supporting Statement NRC Form 396.doc	Supporting Statement A	Uploaded 2012-03-07	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
33230	NRC Form 396, Certification of Medical Examination by Facility Licensee	Form and Instruction	Modified

ICR Details

OMB Control No: 3150-0024	ICR Reference No: 201203-3150-001
Status: Historical Active	Previous ICR Reference No: 200810-3150-003
Agency/Subagency: NRC	Agency Tracking No:
Title: NRC Form 396, Certification of Medical Examination by Facility Licensee
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 04/18/2012
	Date Received in OIRA: 03/15/2012
Terms of Clearance: In accordance with 5 CFR 1320, the information collection is approved for three years.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2015	36 Months From Approved	04/30/2012
Responses	2,160	0	1,427
Time Burden (Hours)	1,215	0	789
Cost Burden (Dollars)	0	0	0

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Abstract: NRC Form 396 is used to transmit information to the NRC regarding the medical condition of applicants for initial operator licenses or renewal of operator licenses and for the maintenance of medical records for all licensed operators. The information is used to determine whether the physical condition and general health of applicants for operator licensees is such that the applicant would not be expected to cause operational errors and endanger public health and safety.

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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:
	76 FR 72983	11/28/2011
30-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 13155	03/05/2012
Did the Agency receive public comments on this ICR? No

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

table that charts list of burden

IC Title	Form No.	Form Name
NRC Form 396, Certification of Medical Examination by Facility Licensee	NRC Form 396	Certification of Medical Examination by Facility Licensee

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ICR Summary of Burden

table that charts list 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	2,160	1,427	0	0	733	0
Annual Time Burden (Hours)	1,215	789	0	0	426	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 number of respondents decreased from 137 to 135 because two non-power facilities have been decommissioned since the last renewal. The overall annual industry reporting burden increased by 223.5 hours from 789 hours to 1,012.5 because of the increase in operators from 4,658 to 4,893; the increase of applicants from 550 to 700; the increase in renewals from 650 to 705, and the increase in the number of disability notices from 90 to 620 for a total increase of submitted NRC Forms 396 from 1,290 to 2,025. The overall annual industry burden to complete and submit the NRC Form 396 increased from .25/hour (15 minutes) to .50/hour (30 minutes) per form based on consultation with licensees on how long it takes to complete this form. The Federal Government's annual reviewing and processing burden increased from .20/hour (12 minutes) to .25/hour (15 minutes) per submitted form. The significant increase in the number of notices of disability, and the increased average industry burden to submit NRC Form 396 is attributed to the aging workforce and increased changes in the general health of licensed operators that requires documentation and medical evidence to support the associated reportable disabilities. The overall annual recordkeeping requirement burden decreased from 466 hours to 202.5 hours because all records required to be stored by the industry are not subject to annual maintenance. Only those submitted to the NRC require annual maintenance. The overall annual industry and Federal Government costs increased from $257,862.23 to $516,107.25 because of the increased industry's reporting burden as outlined above; the Federal Government's increased annual reviewing and processing burden; the change in the NRC's reviewing physician from consultant to contractor status that changed the review cost from an hourly rate to a per form rate, and the additions of storage, mailing and shipping costs. Costs also increased because of the rate change from $238/hr. to $273/hr. During this renewal period, the NRC made clarifying changes to NRC Form 396. This form is used only for Medical Certification. Under "Medical Exam Information," the words "Safeguards and Fitness for Duty" were removed and replaced with the word "Medical." In addition, a new condition was added for the convenience of the users. As a result, the conditions were renumbered to add #5 "Shall Use Therapeutic Device(s) As Prescribed to Maintain Medical Qualifications."

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Annual Cost to Federal Government: $184,412

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: 03/15/2012

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