Information Collection

Human Reliability Program

IC 23449 under ICR 201302-1910-001 · OMB 1910-5122.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1910-5122 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form DOE F 470.3 Human Reliability Program	Form
DOE F 470.3 Human Reliability Program (HRP) Certification 470-3 Revised 5-15-13.docx	Form
DOE F 470.4 Acknowledgement and Agreement to Participate in the Huma 470-4 Revised 5-15-13.docx	Form
DOE F 470.5 Authorization and Consent to Release Human Reliability P 470-5 Revised 5-15-13.docx	Form
DOE F 470.6 Refusal of Consent 470-6.pdf	Form
DOE F 470.7 Human Reliability Program Alcohol Testing 470-7.pdf	Form

IC Title:

Human Reliability Program

Agency IC Tracking Number:

Felecia Briggs

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 10 CFR 712

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	DOE F 470.3	Human Reliability Program (HRP) Certification	470-3 Revised 5-15-13.docx	Yes	No	Printable Only
Form	DOE F 470.4	Acknowledgement and Agreement to Participate in the Human Reliability Program	470-4 Revised 5-15-13.docx	Yes	No	Printable Only
Form	DOE F 470.5	Authorization and Consent to Release Human Reliability Program Records in Connection with HRP	470-5 Revised 5-15-13.docx	Yes	No	Printable Only
Form	DOE F 470.6	Refusal of Consent	470-6.pdf	Yes	No	Printable Only
Form	DOE F 470.7	Human Reliability Program Alcohol Testing	470-7.pdf	Yes	No	Printable Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 43,960

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	43,999	33,659	10,340
Annual IC Time Burden (Hours)	3,873	-2,331	6,204
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.