NRC Form 4, Cumulative Occupational Dose History

Forms and Documents

Document Name	Status
Form NRC Form 4 NRC Form 4, Cumulative Occupational Dose History Form and Instruction	Modified
FINAL supporting statement for NRC Form 4.docx Supporting Statement A	2020-07-28

IC Document Collections

IC ID	Document Title	Status
33127	NRC Form 4, Cumulative Occupational Dose History Form and Instruction	Modified

ICR Details

OMB Control No: 3150-0005	ICR Reference No: 202007-3150-005
Status: Active	Previous ICR Reference No: 201706-3150-007
Agency/Subagency: NRC	Agency Tracking No:
Title: NRC Form 4, Cumulative Occupational Dose History
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 without change	Conclusion Date: 11/03/2020
	Date Received in OIRA: 07/28/2020
Terms of Clearance: In accordance with 5 CFR 1320, this information collection is approved for 3 years.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2023	36 Months From Approved	11/30/2020
Responses	241,014	0	227,841
Time Burden (Hours)	65,954	0	30,348
Cost Burden (Dollars)	6,533	0	2,492

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Abstract: The NRC Form 4 is used to record the summary of an occupational worker’s cumulative occupational radiation dose, including prior occupational exposure and the current year’s occupational radiation exposure. The NRC Form 4 is used by licensees, and inspected by the NRC, to ensure that occupational radiation doses do not exceed the regulatory limits specified in 10 CFR 20.1501.

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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:
	85 FR 21030	04/15/2020
30-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 45452	07/28/2020
Did the Agency receive public comments on this ICR? Yes

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

IC Title	Form No.	Form Name
NRC Form 4, Cumulative Occupational Dose History	Not applicable, NRC Form 4	Cumulative Occupational Dose History ,   Automated Dose History Request Form

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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	241,014	227,841	0	0	13,173	0
Annual Time Burden (Hours)	65,954	30,348	0	0	35,606	0
Annual Cost Burden (Dollars)	6,533	2,492	0	0	4,041	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: The estimated burden has increased by 35,606 hours from the previous burden of 30,348 hours to 65,954 hours. The burden increase is primarily due to an increase in the number of records that fell under the recordkeeping burden. Previous burden estimates have assumed the recordkeeping burden was only for records subject to 10 CFR 20.2206(a). However, licensees not subject to 10 CFR 20.2206(a) must still maintain these records using a NRC Form 4 or its equivalent. The NRC staff has corrected this in the current submission. In the current estimates all records are included under the recordkeeping. As a result, the number of records that fell under the recordkeeping burden increased from 168,751 to 234,988. In addition, in the previous clearance, based on REIRS data, NRC estimated that licensees would maintain NRC Form 4, or its equivalent, records for 40,681 transient workers. A review of recent REIRS data shows that as of June 2019, licensees-maintained NRC Form 4, or its equivalent, records for an average of 47,926 transient workers annually. Recordkeeping burden increased from 23,508 hours to 58,787 hours. NRC staff adjusted recordkeeping burden estimates for Form 4. The previous recordkeeping burden was estimated to be 35 minutes. This estimate assumed that a person would be manually entering the dose record information into the NRC Form 4. With electronic software more readily available and more commonly used to manage dose records, this estimate was determined to be too conservative. A new estimate of 15 minutes is more representative of current record management processes. It should be noted that the NRC does not anticipate any planned special exposures during the next three years. Additional costs associated with records storage have increased from $2,492 to $6,533 (an increase of $4,041) due to an increase in the recordkeeping burden and an increase in the fee rate used to calculate the costs. The fee rate has increased from $265 to $278 per hour.

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Annual Cost to Federal Government: $139,834

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     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? No

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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: 07/28/2020

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