Human Reliability Program

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1910-5122 can be found here:

Documents and Forms

Document Name Document Type
Form DOE F 470.3 Human Reliability Program Form
DOE F 470.3 Human Reliability Program (HRP) Certification DOE F 470.3 Human Reliability Program (HRP) Certification.pdf Form
DOE F 470.4 Acknowledgement and Agreement to Participate in the Huma DOE F 470.4 Acknowledgement and Agreement to Participate in the Human Reliability Ptogram (HRP).pdf Form
DOE F 470.5 Authorization and Consent to Release Human Reliability P DOE F 470.5 Authorization and Consent to Release Human Reliability Program Records in Connection with HRP.pdf Form
DOE F 470.6 Refusal of Consent DOE F 470.6 Rufusal to Consent.pdf Form
DOE F 470.7 Human Reliability Program Alcohol Testing DOE F 470.7 Human Reliability Program Alcohol Testing.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Human Reliability Program	Agency IC Tracking Number:	Sandy Dentinger (AU)

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 10 CFR 712

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	DOE F 470.3	Human Reliability Program (HRP) Certification	DOE F 470.3 Human Reliability Program (HRP) Certification.pdf	Yes	No	Printable Only
Form	DOE F 470.4	Acknowledgement and Agreement to Participate in the Human Reliability Program	DOE F 470.4 Acknowledgement and Agreement to Participate in the Human Reliability Ptogram (HRP).pdf	Yes	No	Printable Only
Form	DOE F 470.5	Authorization and Consent to Release Human Reliability Program Records in Connection with HRP	DOE F 470.5 Authorization and Consent to Release Human Reliability Program Records in Connection with HRP.pdf	Yes	No	Printable Only
Form	DOE F 470.6	Refusal of Consent	DOE F 470.6 Rufusal to Consent.pdf	Yes	No	Printable Only
Form	DOE F 470.7	Human Reliability Program Alcohol Testing	DOE F 470.7 Human Reliability Program Alcohol Testing.pdf	Yes	No	Printable Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 43,960	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	43,999	0	43,999
Annual IC Time Burden (Hours)	3,819	-54	3,873
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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.