NRC Form 396, Certification of Medical Examination by Facility Licensee

Forms and Documents

Document Name	Status
Form NRC Form 396 NRC Form 396, Certification of Medical Examination by Facility Licensee Form and Instruction	Modified
30-dayFRNForm396.pdf Supplementary Document	2015-01-27
OMB-3150-0024, NRC form 396 Final Supporting Statement Rev 080415.doc Supporting Statement A	2015-08-04

IC Document Collections

IC ID	Document Title	Status
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: 201501-3150-009
Status: Historical Active	Previous ICR Reference No: 201203-3150-001
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 with change	Conclusion Date: 03/02/2016
	Date Received in OIRA: 02/04/2015
Terms of Clearance: In accordance with 5 CFR 1320, the information collection is approved for three years. However, as a term of clearance, the Agency is required to calculate burden based on the estimated burden for the three year period approved by this ICR and not based on the actual burden of the previous 3 years.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2019	36 Months From Approved	03/31/2016
Responses	2,131	0	2,160
Time Burden (Hours)	1,968	0	1,215
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:
	79 FR 61105	10/09/2014
30-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 3993	01/26/2015
Did the Agency receive public comments on this ICR? No

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

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

	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	2,131	2,160	0	0	-29	0
Annual Time Burden (Hours)	1,968	1,215	0	0	753	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: Even though the number of reporting facilities decreased from 135 to 131 due to decommissioning, the overall number of submissions decreased by only 25 from 2,025 to 2,000 because the number of applicants decreased from 700 to 660; the number of renewals decreased from 705 to 700, but the number of disability reports increased from 620 to 640. The overall annual industry reporting burden increased by 655.5 hours from 1,012.5 hours to 1,668 hours because the time to complete and submit the NRC Form 396 increased by .334 hour (20 minutes) from .50 hour (30 minutes) to .834 hour (50 minutes) as reported by the industry. The overall annual recordkeeping requirement burden increased from 202.5 hours to 300 hours because the time involved for each record subject to annual maintenance increased by .05 hour (3 minutes) from .10 hour (6 minutes) to .15 hour (9 minutes) as reported by the industry. The change in the rate from $273/hr. to $279/hr. had little impact on the costs. The overall annual industry and Federal Government costs increased by $114,472.75 from $516,107.25 to $630,580 because of the increased costs as reported by the industry, and the increase in the cost of the NRC Medical Review Officer's services. The change in the rate from $273/hr. to $279/hr. had little impact on the costs.

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Annual Cost to Federal Government: $188,000

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: 02/04/2015

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