Request letters on 1) Comment on Procedure SA-105 for Reviewing the Common Performance Indicator; 2 & 3) Comment on Draft NorthStar and Yttrium Licensing Guidance; and 4) Request for Assistance Iden

Requests to Agreement States For Information

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3150-0029 can be found here:

Documents and Forms

Document Name Document Type
Comment Request letter on Procedure SA105.docx Other-Comment Request
Request For Assistance For Identifying Licensees Using I-133 Therapeutically.docx Other-Request for Assistance
Generic Submission Template for Draft Revised Yttrium-90 Microsphere Licensing Guidance.pdf Generic Submission Template for Draft Revised Yttrium-90 Microsphere Licensing Guidance IC Document
Generic Submission Template for Request for Agreement State Assistance Related to Licensees Using I-133 To Treat Patients.pdf Generic Submission Template for Request for Agreement State Assistance Related to Licensees Using I-133 To Treat Patients IC Document
Generic submission template for comment request letter on SA105.pdf Generic submission template for comment request letter on SA105 IC Document
Generic submission template for comment request on draft Northstar licensing guidance.pdf Generic submission template for comment request on draft Northstar licensing guidance IC Document
Procedure SA105 Reviewing the Common Performance Indicator.docx Procedure SA105 Reviewing the Common Performance Indicator IC Document
I-131 Patient Release Questionnaire.pdf I-131 Patient Release Questionnaire IC Document

Information Collection (IC) Details

IC Title:	Request letters on 1) Comment on Procedure SA-105 for Reviewing the Common Performance Indicator; 2 & 3) Comment on Draft NorthStar and Yttrium Licensing Guidance; and 4) Request for Assistance Iden	Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Comment Request			Comment Request letter on Procedure SA105.docx		Yes	Yes	Fillable Fileable
Other-Request for Assistance			Request For Assistance For Identifying Licensees Using I-133 Therapeutically.docx		Yes	Yes	Fillable Fileable

Line of Business: Energy

Subfunction: Energy Production

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 156	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	156	156
Annual IC Time Burden (Hours)	390	390
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Generic Submission Template for Draft Revised Yttrium-90 Microsphere Licensing Guidance	Generic Submission Template for Draft Revised Yttrium-90 Microsphere Licensing Guidance.pdf	08/03/2016
Generic Submission Template for Request for Agreement State Assistance Related to Licensees Using I-133 To Treat Patients	Generic Submission Template for Request for Agreement State Assistance Related to Licensees Using I-133 To Treat Patients.pdf	08/03/2016
Generic submission template for comment request letter on SA105	Generic submission template for comment request letter on SA105.pdf	08/03/2016
Generic submission template for comment request on draft Northstar licensing guidance	Generic submission template for comment request on draft Northstar licensing guidance.pdf	08/03/2016
Procedure SA105 Reviewing the Common Performance Indicator	Procedure SA105 Reviewing the Common Performance Indicator.docx	08/03/2016
I-131 Patient Release Questionnaire	I-131 Patient Release Questionnaire.pdf	08/03/2016

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