NRC Form 396, Certification of Medical Examination by Facility Licensee

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form NRC FORM 396 CERTIFICATION OF MEDICAL EXAMINATION BY FACILITY LICENSEE - Current Form	Form and Instruction	Modified	Available
Form NRC Form 396 CERTIFICATION OF MEDICAL EXAMINATION BY FACILITY LICENSEE with EDITS	Form and Instruction	Modified	Available
Form NRC Form 396 NRC Form 396, Certification of Medical Examination by Facility Licensee	Form and Instruction	Modified	Repair queued
Nonsubstantive Change Request for Form 396 (Instructions).docx	Justification for No Material/Nonsubstantive Change	Uploaded 2023-03-13	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
33230	NRC Form 396, Certification of Medical Examination by Facility Licensee	Form and Instruction	Modified	CERTIFICATION OF MEDICAL EXAMINATION BY FACILITY LICENSEE - Current Form
33230	NRC Form 396, Certification of Medical Examination by Facility Licensee	Form and Instruction	Modified	CERTIFICATION OF MEDICAL EXAMINATION BY FACILITY LICENSEE with EDITS
33230	NRC Form 396, Certification of Medical Examination by Facility Licensee	Form and Instruction	Modified

ICR Details

OMB Control No: 3150-0024	ICR Reference No: 202303-3150-002
Status: Historical Active	Previous ICR Reference No: 202205-3150-006
Agency/Subagency: NRC	Agency Tracking No:
Title: NRC Form 396, Certification of Medical Examination by Facility Licensee
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 05/18/2023
Retrieve Notice of Action (NOA)	Date Received in OIRA: 03/20/2023
Terms of Clearance: In accordance with 5 CFR 1320, the non-substantive change request is approved.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2025	12/31/2025	12/31/2025
Responses	1,778	0	1,778
Time Burden (Hours)	2,063	0	2,063
Cost Burden (Dollars)	48	0	48

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Abstract: NRC Form 396 is used to transmit information to the NRC regarding the medical condition of applicants for initial operator licenses or renewal of operator licenses and for the maintenance of medical records for all licensed operators. The information is used to determine whether the physical condition and general health of applicants for operator licensees is such that the applicant would not be expected to cause operational errors and endanger public health and safety.

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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:
	87 FR 5520	02/01/2022
30-day Notice:	Federal Register Citation:	Citation Date:
	87 FR 33215	06/01/2022
Did the Agency receive public comments on this ICR? No

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

table that charts list of burden

IC Title	Form No.	Form Name
NRC Form 396, Certification of Medical Examination by Facility Licensee	NRC FORM 396, NRC Form 396	CERTIFICATION OF MEDICAL EXAMINATION BY FACILITY LICENSEE with EDITS ,   CERTIFICATION OF MEDICAL EXAMINATION BY FACILITY LICENSEE - Current Form

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ICR Summary of Burden

table that charts list 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	1,778	1,778	0	0	0	0
Annual Time Burden (Hours)	2,063	2,063	0	0	0	0
Annual Cost Burden (Dollars)	48	48	0	0	0	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 burden for the information collection decreased from 2,196 hours to 2,063 hours, a decrease of 133 hours. The number of total responses overall has decreased from 1,882 (1,757 responses + 125 recordkeepers) to 1,778 (1,650 Responses + 128 Recordkeepers), a decrease of 104 responses. However, due to a data entry oversight in the previous cycle, recordkeepers were not included in the total number of responses, therefore ROCIS totals show an increase of 21 responses in this submission. NRC Form 396 is the mechanism by which NRC is advised of the applicant/operator general health and physical condition, and when a facility and/or individual is no longer subject to the requirements of 10 CFR Part 55, they will no longer submit NRC Form 396. Therefore, the decrease in projected submissions is due to the decrease in licensed individuals and operating reactor plants being subject to Part 55 requirements. There is a projected minimal increase in respondents up from 125 (94 operating reactors + 31 research and test reactor facilities) in the prior cycle to 128 (89 operating reactors + 31 research and test reactor facilities + 8 combined operating license holders), this increase is due to the addition of eight Combined Operating License Holders who are subjected to the requirements of 10 CFR Part 55 and a reduction of 5 operating reactor facilities no longer licensed and are not subject to the requirements of 10 CFR Part 55. There is an approximately 50% increase in NRC Contractor Licensed Physician review fee per form per agreed contract. There is a minimal increase in projected disability submissions, up 10 submissions annually from 530 in the prior cycle to 540 for this cycle. Staff believes this is a reasonable projection in line with current health trend data. Additionally, NRC currently uses the EIE, OSM, facsimile, or e-mail to deliver NRC Form 396s and receive the completed medical reviews from the NRC Contractor. The agency no longer uses mailing/shipping services to deliver forms to the NRC Contractor, which eliminated the prior mailing/shipping costs.

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Annual Cost to Federal Government: $180,444

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: 03/20/2023

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