Dosimetry Application and Record of Previous Radiation Exposure

Radiation Exposure Data Collection

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0702-0150 can be found here:

Documents and Forms

Document Name Document Type
Form DD 1952 Dosimetry Application and Record of Previous Radiation Exposure Form
DD 1952 Dosimetry Application and Record of Previous Radiation E DD1952 DRAFT 20210518.pdf Form
DD 1952 Dosimetry Application and Record of Previous Radiation E DD1952 DRAFT 20210518.pdf Form
0702-RADS_DD1952_SSN_12.19.2020.pdf SSN Justification Memo IC Document
0702-RADS_DD1952_SSN_12.19.2020.pdf SSN Justification Memo IC Document

Information Collection (IC) Details

IC Title:	Dosimetry Application and Record of Previous Radiation Exposure	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	DD 1952	Dosimetry Application and Record of Previous Radiation Exposure	DD1952 DRAFT 20210518.pdf		Yes	Yes	Fillable Fileable Signable

Line of Business: Defense and National Security

Subfunction: Operational Defense

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 25	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 80 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	25	25
Annual IC Time Burden (Hours)	6	6
Annual IC Cost Burden (Dollars)	187	187

Documents for IC

Title	Document	Date Uploaded
SSN Justification Memo	0702-RADS_DD1952_SSN_12.19.2020.pdf	06/02/2021

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