Information Collection

Acknowledgement and Agreement to Participate in the Human Reliability Program (HRP)

IC 44890 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⚠️ Notice: This information collection may be referencing outdated material.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 470.4 Acknowledgement and Agreement to Participate in the Human Reliability Program (HRP)	Form
DOE F 470.4 Acknowledgment and Agreement to Participate in the Human 470-4[1].pdf	Form

IC Title:

Acknowledgement and Agreement to Participate in the Human Reliability Program (HRP)

Agency IC Tracking Number:

Felecia Briggs

Is this a Common Form? No

IC Status: Removed

Obligation to Respond: Mandatory

CFR Citation: 10 CFR 710, 711, and 712 (To search for a specific CFR, visit the Code of Federal Regulations.)

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	DOE F 470.4	Acknowledgment and Agreement to Participate in the Human Reliability Program (HRP)	470-4[1].pdf		Yes	No	Printable Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 10,340

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	-10,340	10,340
Annual IC Time Burden (Hours)	-6,204	6,204
Annual IC Cost Burden (Dollars)	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.