Justification for Nonsubstantive Change NRC Form 396

NRC Form 396, Certification of Medical Examination by Facility Licensee,

Nonsubstantive Change Request

The Nuclear Regulatory Commission (NRC) is submitting this nonsubstantive change request in order to make updates to NRC Form 396, “Certification of Medical Examination by Facility Licensee”. This form has been previously cleared under 3150-0024. This form is used to evaluate medical suitability of an individual applying for, or renewing, an operator license per Title 10 of the Code of Federal Regulations (10 CFR), Part 55, “Operators’ licenses.” The information provided in this form allows the NRC to evaluate medical status of a licensed operator or applicant and apply any necessary medical license restrictions.

The proposed changes would address feedback received from form users and NRC operator licensing assistants, and have been initiated to better align with the recent revision of NUREG‑‑1021, “Operator Licensing Examination Standards for Power Reactors, Rev. 11.” The public comment period on NUREG-1021, Rev 11 closed on May 6th, 2017. These changes would improve the usability of the form and the accuracy and consistency of information reported. No change in burden is anticipated as a result of these changes. No significant changes to the amount of additional information being collected have been noted. No new regulatory requirements have been initiated.

The NRC is proposing the following changes to NRC Form 396, Certification of Medical Examination by Facility Licensee:

• Added an applicant mailing address block to ensure that the NRC has the current mailing address for an individual applicant/licensed operator. The mailing address is required in order to issue initial/amended licenses and inform the operator of any new or updated license restrictions related to the individual’s medical status. The applicant’s mailing address is originally collected via NRC Form 398. Applicants/operators are required to update the NRC with changes in medical status via NRC Form 396, therefore an update mailing address is required.

• Added a 10 CFR Part 52 Facility Docket check box to support operator license applications for those facilities licensed under 10 CFR 52.

• Updated check blocks to allow applicants to certify their medical status using the most recent revisions of ANSI/ANS 3.4-2013 and ANSI/ANS 15.4-2016.

• Added Physician’s Certification date (date of medical examination) in order to support NRC verification of the two-year medical examination requirement for licensed operators.

• Added applicant Name and Docket Number to the second page of the form to ensure more effective and efficient document tracking and processing.

• Added an applicant acknowledgement statement and applicant signature/date to ensure that the individual applicant acknowledges the details of the medical certification being submitted in support of his or her license application and authorizes the release of the medical information to the NRC.

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