Information Collection

Form NIST-366A: Request for Personal Radiation Monitoring Services

IC 241904 under ICR 202005-0693-001 · OMB 0693-0086.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0693-0086 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form NIST-366A Form NIST-366A: Request for Personal Radiation Monitoring Services	Form
NIST-366A Request for Personal Radiation Monitoring Services NIST-366A Dosimetry Request.pdf	Form
SORN NIST-5.docx SORN NIST 5	IC Document
published 60 Day FRN.pdf 60 Day FRN	IC Document
Dosimetry Supporting Statement.docx supporting statement	IC Document
30 Day FRN published.pdf 30 Day FRN	IC Document
10 CFR 20.1502 Citation.docx CFR 20.1502 citation	IC Document
Citation of § 20.2106.docx CFR 20.2106 citation	IC Document

IC Title:

Form NIST-366A: Request for Personal Radiation Monitoring Services

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Mandatory

CFR Citation: 10 CFR 20.2106 10 CFR 20.1502

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	NIST-366A	Request for Personal Radiation Monitoring Services	NIST-366A Dosimetry Request.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title: NIST 5

FR Citation: 74 FR 50770

Number of Respondents: 600

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 50 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	600	600
Annual IC Time Burden (Hours)	150	150
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
SORN NIST 5	SORN NIST-5.docx	05/20/2020
60 Day FRN	published 60 Day FRN.pdf	05/20/2020
supporting statement	Dosimetry Supporting Statement.docx	05/28/2020
30 Day FRN	30 Day FRN published.pdf	05/28/2020
CFR 20.1502 citation	10 CFR 20.1502 Citation.docx	05/28/2020
CFR 20.2106 citation	Citation of Â§ 20.2106.docx	05/28/2020

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