NRC Form 5, Occupational Exposure Record for a Monitoring Period

Forms and Documents

Document Name	Status
Form NRC Form 5 NRC Form 5, Occupational Exposure Record for a Monitoring Period Form	Modified
Final Supporting Statement_NRC Form 5.doc Supporting Statement A	2014-05-08
2014-10112.pdf Supplementary Document	2014-05-08

IC Document Collections

IC ID	Document Title	Status
33130	NRC Form 5, Occupational Exposure Record for a Monitoring Period Form	Modified

ICR Details

OMB Control No: 3150-0006	ICR Reference No: 201405-3150-002
Status: Historical Active	Previous ICR Reference No: 201006-3150-009
Agency/Subagency: NRC	Agency Tracking No:
Title: NRC Form 5, Occupational Exposure Record for a Monitoring Period
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 10/30/2014
	Date Received in OIRA: 05/29/2014
Terms of Clearance: In accordance with 5 CFR 1320, the information collection request is approved for three years. OMB requests that when the agency submits the package for renewal that it conduct consultations with up to 9 outside entities and incorporate those findings into the ICR package.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2017	36 Months From Approved	10/31/2014
Responses	4,346	0	4,042
Time Burden (Hours)	130,852	0	68,556
Cost Burden (Dollars)	13,584	0	0

---

Abstract: NRC Form 5 is used to record and report the results of individual monitoring for occupational radiation exposure during a monitoring (one calendar year) period to ensure regulatory compliance with annual radiation dose limits specified in 10 CFR 20.1201.

---

Authorizing Statute(s): PL: Pub.L. 83 - 703 1-311 Name of Law: Atomic Energy Act
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 6935	02/05/2014
30-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 25156	05/02/2014
Did the Agency receive public comments on this ICR? No

---

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

IC Title	Form No.	Form Name
NRC Form 5, Occupational Exposure Record for a Monitoring Period	NRC Form 5	Occupational Dose Record for a Monitoring Period

---

ICR Summary 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	4,346	4,042	0	0	304	0
Annual Time Burden (Hours)	130,852	68,556	0	53,816	8,480	0
Annual Cost Burden (Dollars)	13,584	0	0	0	13,584	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: The estimated burden has increased by 62,296 hours from the previous burden of 68,556 hours to 130,852 hours (6,000 reporting plus 124,852 recordkeeping). This burden change is due to an increase in the number of monitored individuals at licensee facilities pursuant to 10 CFR 20.1501. The increase in the number of monitored individuals increases the number of records received by the NRC. In addition to the increase in the number of monitored individuals, there was an increase in the total number of materials licensees that reported occupational dose data to the NRC. The materials licensee data submitted was by NRC materials licensees and Agreement State materials licensees. In the previous clearance, NRC received 173,419 records. As of June 2013, NRC received 215,262 records (204,524 electronic records + 10,738 paper records). In addition, the professional cost per hour has increased from $257/hr to $272/hr. The number of responses has increased from 4,042 to 4,346. This change is due to the increase in the number of reporting responses and an increase in the number of recordkeepers. In the previous clearance period, there were 194 reporting responses and 3,848 recordkeepers. In this clearance, there are 200 reporting responses and 4,146 recordkeepers. Each recordkeeper has been counted as a single response, regardless of the number of records kept. Therefore, the number of responses is equal to the number of reporting responses plus the number of recordkeepers. Most of the increase in burden can be attributed to the change in the estimated recordkeeping burden due to the additional of the EDEX field. The EDEX field increased recordkeeping burden from .33 hrs per record to .58 hrs per record, an increase of .25 hrs per record. With 215,262 records annually, this change accounts for 53,815.5 hours (215,262 records x an increase of .25 hrs per record).

---

Annual Cost to Federal Government: $620,432

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

---

Common Form ICR:  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:

(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: 05/29/2014

---