DOE/NRC Form 742 Material Balance Report

APPROVED BY OMB: NO. 3150-0004
EXPIRES: (MM/DD/YYYY)
U.S. DEPARTMENT OF ENERGY
Estimated burden per response to comply with this mandatory collection request: 2 hours for
AND
U.S. NUCLEAR REGULATORY COMMISSION small licensees and 5 hours for large licensees. Reported lessons learned are incorporated

DOE/NRC FORM 742

(MM--YYYY)
MANDATORY DATA
COLLECTION
AUTHORIZED BY
10 CFR 30, 40, 50, 70, 72,
74, 75, 150, Public Laws
83-703, 93-438, 95-91

into the licensing process and fed back to industry. Send comments regarding burden
estimate to the Information Services Branch (T-6 A10M), U.S. Nuclear Regulatory
Commission, Washington, DC 20555-0001, or by e-mail to [email protected],
and to the Desk Officer, Office of Information and Regulatory Affairs, NEOB-10202,
(3150-0004), 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.

MATERIAL BALANCE REPORT

1. NAME AND ADDRESS

2. LICENSE NUMBER(S)

4. REPORT PERIOD (MM/DD/YYYY)
FROM

SECTION A
PC

SEQ

TO

3. REPORTING IDENTIFICATION
SYMBOL (RIS)

5. MATERIAL TYPE
(Submit separate report for each type)

MATERIAL ACCOUNTABILITY
A. ELEMENT WEIGHT

B. ISOTOPE WEIGHT

8. BEGINNING INVENTORY -- U.S. GOVT-OWNED
9. BEGINNING INVENTORY -- NOT U.S. GOVT-OWNED
RECEIPTS
11. PROCUREMENT FROM DOE RIS
FROM:

13.
14.
15.
16.
21.
22.

PROCUREMENT -- FOR THE ACCOUNT OF DOE
DOD RETURNS -- USE A
DOD RETURNS -- USE B
DOD RETURNS -- OTHER USES
PRODUCTION
FROM OTHER MATERIALS
a. ICT
b. ICT
c. ICT

30. RECEIPTS REPORTED TO DOE/NRC ON DOE/NRC 741 (not listed elsewhere)

FROM:

RIS

34.
37.
38.
39.
40.

RECEIPTS -- MISC
PROCUREMENT BY OTHERS
DONATED MATERIAL -- FROM U.S. GOVT TO OTHERS
DONATED MATERIAL -- FROM OTHERS TO U.S. GOVT
TOTAL (Lines 8-39)
REMOVALS
41. EXPENDED IN SPACE PROGRAMS
42. SALES TO U.S. GOVT RIS TO:
RIS
TO:
43. SALES TO OTHERS FOR THE ACCOUNT OF U.S. GOVT

TO:
44.
45.
46.
47.
48.
49.

RIS

DOD -- USE A
DOD -- USE B
DOD -- OTHER USES
EXPENDED IN U.S. GOVT TESTS
ROUTINE TESTS
SHIPPER -- RECEIVER DIFFERENCE

51. SHIPMENTS REPORTED TO NRC/DOE ON NRC/DOE 741 (not listed elsewhere)

TO:

NRC FORM 742 (MM-YYYY)

RIS

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DOE/NRC FORM 742

U.S. DEPARTMENT OF ENERGY
AND
U.S. NUCLEAR REGULATORY COMMISSION

(MM-YYYY)
10 CFR 30, 40, 50, 70, 72,
74, 75, 150, Public Laws
83-703, 93-438, 95-91

MATERIAL BALANCE REPORT (Continued)
SECTION A (Continued)
PC

MATERIAL ACCOUNTABILITY

SEQ
54.
58.
59.
65.

72.
73.
74.
75.
76.

SHIPMENTS -- MISC
DONATED MATERIAL -- TO U.S. GOVT BY OTHERS
DONATED MATERIAL -- TO OTHERS BY U.S. GOVT
ROUNDING ADJUSTMENT
DEGRADATION TO OTHER MATERIALS
a. ICT
b. ICT
DECAY
FISSION AND TRANSMUTATION
NORMAL OPERATIONAL LOSSES/MEASURED DISCARDS
ACCIDENTAL LOSSES
APPROVED WRITE-OFFS

77.
80.
81.
82.

INVENTORY DIFFERENCE
ENDING INVENTORY -- U.S. GOVT OWNED
ENDING INVENTORY -- NOT U.S. GOVT OWNED
TOTAL (Lines 41-81)

71.

A. ELEMENT WEIGHT B. ISOTOPE WEIGHT

83. BIAS ADJUSTMENT

SECTION B
PC

SEQ

FOREIGN OBLIGATIONS
1. COUNTRY OF OBLIGATION

2. ELEMENT WEIGHT 3.

ISOTOPE WEIGHT

4. TOTAL WEIGHT

SECTION C

CERTIFICATION

To the best of my knowledge and belief, the information given above and in any attached schedules is true, complete, and correct.
SIGNATURE (See instructions for provisions on confidentially)

TITLE

DATE

WARNING: FALSE STATEMENTS IN THIS CERTIFICATE MAY BE SUBJECT TO CIVIL, AND/OR CRIMINAL PENALTIES. NRC REGULATIONS
REQUIRE THAT SUBMISSIONS TO THE NRC BE COMPLETE AND ACCURATE IN ALL MATERIAL RESPECTS. 18 U.S.C. SECTION 1001
MAKES IT A CRIMINAL OFFENSE TO MAKE A WILLFULLY FALSE STATEMENT OR REPRESENTATION TO ANY DEPARTMENT OR AGENCY
OF THE UNITED STATES AS TO ANY MATTER WITHIN ITS JURISDICTION.
NRC FORM 742 (MM-YYYY)

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