Human Reliability Program

Documents and Forms

Document Name Document Type
Form DOE F 470.3 Human Reliability Program Form
DOE F 470.3 Human Reliability Program (HRP) Certification DOE F 470.3 (Human Reliability Program (HRP) Certification).FINAL.pdf Form
DOE F 470.4 Acknowledgement and Agreement to Participate In The Huma DOE F 470.4 (Acknowledgment and Agreement To Participate In The Human Reliability Program (HRP)).FINAL.pdf Form
DOE F 470.5 Authorization and Consent to Release Human Reliability P DOE F 470.5 Authorization and Consent To Release Human Reliability Program (HRP) Records In Connection With HRP).FINAL.pdf Form
DOE F 470.7 Human Reliability Program (HRP) Alcohol Testing Form DOE F 470.7 (Human Reliability Program (HRP) Alcohol Testing Form).FINAL.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Human Reliability Program	Agency IC Tracking Number:	Sandy Dentinger (AU)

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 10 CFR 712

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	DOE F 470.3	Human Reliability Program (HRP) Certification	DOE F 470.3 (Human Reliability Program (HRP) Certification).FINAL.pdf	Yes	Yes	Fillable Fileable
Form	DOE F 470.4	Acknowledgement and Agreement to Participate In The Human Reliability Program (HRP)	DOE F 470.4 (Acknowledgment and Agreement To Participate In The Human Reliability Program (HRP)).FINAL.pdf	Yes	Yes	Fillable Fileable
Form	DOE F 470.5	Authorization and Consent to Release Human Reliability Program (HRP)	DOE F 470.5 Authorization and Consent To Release Human Reliability Program (HRP) Records In Connection With HRP).FINAL.pdf	Yes	Yes	Fillable Fileable
Form	DOE F 470.7	Human Reliability Program (HRP) Alcohol Testing Form	DOE F 470.7 (Human Reliability Program (HRP) Alcohol Testing Form).FINAL.pdf	Yes	No	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 41,321	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	41,365	-2,634	43,999
Annual IC Time Burden (Hours)	3,587	-232	3,819
Annual IC Cost Burden (Dollars)	315,656	-16,597	332,253

Documents for IC

Title	Document	Date Uploaded
No associated records found

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