The agency is
reminded to consult on the information collection prior to
submission for review per 5 CFR 1320.8(d)(1).
Inventory as of this Action
Requested
Previously Approved
08/31/2017
36 Months From Approved
08/31/2014
227,846
0
3,848
31,234
0
18,410
0
0
0
The NRC Form 4 is used to record the
summary of an occupational worker's cumulative occupational
radiation dose, including prior occupational exposure and the
current year's occupational radiation exposure. The NRC Form 4 is
used by licensees, and inspected by the NRC, to ensure that
occupational radiation doses do not exceed the regulatory limits
specified in 10 CFR 20.1501.
The estimated burden has
increased by 12,824 hours from the previous burden of 18,410 hours
to 31,234 hours. This increase has three primary reasons: 1) the
increase in the number of transient workers, 2) the increase in the
burden estimate by 5 minutes based on the inclusion of the new EDEX
field on the form, and 3) the inclusion of 3rd party disclosure
burden for the NRC Form 4. In addition to the increase in the
number of transient workers, licensees provide an NRC Form 4 (or
equivalent) to their employees even if the employee has not
participated in a planned special exposure (2007 final rule).
Licensees provide an NRC Form 4 (or equivalent) to employees
pursuant to 10 CFR 19.13. Due to an increase in the number of
transient workers, the number of hours associated with NRC Form 4
is anticipated to be higher in the current renewal cycle than in
previous cycles: • In the previous clearance (prior to the 2007
final rule), based on REIRS data, NRC estimated that licensees
would maintain NRC Form 4, or its equivalent, records for 28,780
transient workers. A review of recent REIRS data shows that as of
June 2013, licensees maintained NRC Form 4, or its equivalent,
records for an average of 33,518 transient workers annually. In
addition to licensees in the REIRS system, in the current
clearance, NRC has included the transient workers employed by 3,946
additional materials licensees. These licensees are not subject to
20.2206(a); therefore, their data is not included in the REIRS
system. These licensees were not included in the estimates in the
previous clearance; however, NRC inspection findings indicate that
these licensees are voluntarily maintaining NRC Form 4 for their
workers. The NRC estimates that these licensees are maintaining
Form 4 for an additional 8,760 transient workers. The addition of
these 3,946 sites to the estimates has greatly increased the
estimated number of respondents. The second reason for the increase
in the estimated burden is an increase in the estimated time to
complete NRC Form 4, from 30 minutes to 35 minutes. Prior to the
2007 final rule, the estimate to complete NRC Form 4 was 30
minutes. Because it takes less time to complete NRC Form 4 for a
planned special exposure, the burden was reduced to 15 minutes.
However, because licensees primarily use the NRC Form 4 to record
an employee's cumulative exposure, the burden estimate was changed
to 30 minutes. The burden estimate has further changed from 30
minutes to 35 minutes to include the new "EDEX" field. The addition
of this field is needed so that licensees can comply with the
definition of the total effective dose equivalent (TEDE) in 10 CFR
20.1003. The change in TEDE definition was part of the December
2007 final rule on 10 CFR Parts 19, 20, and 50 (72 FR 68043). This
change of 5 minutes accounts for 345 hours of burden, and has been
accounted for as a program change due to agency discretion.
Finally, in addition to taking 35 minutes to complete the NRC Form
4, in this renewal, an additional 2 minutes per worker has been
added to account for the time spent by licensees to provide a copy
of the NRC Form 4 to their workers. The NRC staff estimates that
licensees use an additional 2 minutes to print the form (or its
equivalent) and provide it to their employees. This is not a change
in requirements, but a change in how the NRC is accounting for the
3rd-party disclosure aspect of the collection. This resulted in an
additional 6,711 hours for this clearance. It should be noted that
the NRC does not anticipate any planned special exposures during
the next three years; therefore, all licensees that use the NRC
Form 4 for the next three years will be on a voluntary basis.
$138,230
No
No
No
No
No
Uncollected
Doris Lewis 301
251-7559
No
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:
(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;
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.
Form NRC Form 4 NRC Form 4, Cumulative Occupational Dose History
Final NRC Form 4 SS.doc
NRC Form 4, Cumulative Occupational Dose History