NRC Form 5, Occupational Exposure Record for a Monitoring Period

REIRS and REMS File Submission Form
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Type Of Data:
ANNUAL - NRC:
Individual monitoring records reported under 10 CFR 20.2206 (http://www.nrc.gov/reading-rm/doccollections/cfr/part020/part020-2206.html), and Reg Guide 8.7
(http://pbadupws.nrc.gov/docs/ML0529/ML052970092.pdf), including corrected reports for prior years.
ANNUAL - DOE:
Individual monitoring records reported under 10 CFR 835 (http://energy.gov/ehss/occupational-radiationprotection-program-10-cfr-835), and REMS Reporting Guide
(http://energy.gov/sites/prod/files/2015/12/f27/REMS_Reporting_Guide.pdf), including corrected reports for prior
years.
ANNUAL - Agreement State:
Individual monitoring records, including corrected reports for prior years.
___________________________________________________________
Special Individuals - DOE:

Monitoring records for Special Individuals as defined in DOE O 231.1B, Attachment 4,2(a)
(https://www.directives.doe.gov/directives-documents/200-series/0231.1-BOrder-b-admchg1)
Test Data or Other:
Records or data files requiring further examination or analysis from the Project Manager. Contact the PM
(mailto:[email protected];[email protected]?Subject=File%20Submission) in advance.
Dose History Request Documentation:
Release Forms and/or Supporting Documentation for Dose History Requests

Submit Data File
Paperwork Reduction Act Statement for NRC Respondents
APPROVED BY OMB NO. 3150-0006, expires 10/31/2020
Estimated burden per response to comply with this mandatory collection request: 20 minutes. This information is
used to ensure that doses to individual do not exceed regulatory limits. This information is required to
record/annually report individual occupational exposure to radiation to ensure that the exposure does not exceed
regulatory limits. Send comments regarding burden estimate to the Information Services Branch (T6 A10M), U.S.
Nuclear Regulatory Commission, Washington, DC 20555-0001, or by e-mail to [email protected]
(mailto:[email protected]), and to the Desk Officer, Office of Information and Regulatory Affairs,
NEOB-10202, (3150-0006), Office of Management and Budget, Washington, DC 20503. If a means used to impose
an information collection does not display a currently valid OMB control number, the NRC may not conduct or
sponsor, and a person is not required to respond to, the information collection.