Information Collection

Form NIST-366A: Request for Personal Radiation Monitoring Services

IC 241904 under ICR 202306-0693-001 · OMB 0693-0086.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form NIST-366A Form NIST-366A: Request for Personal Radiation Monitoring Services	Form
NIST-366A Request for Personal Radiation Monitoring Services Collection Instrument Form NIST-366a.pdf	Form
NIST-366A Request for Personal Radiation Monitoring Services Collection Instrument Form NIST-366a_updated.pdf	Form
SORN NIST-5.docx SORN NIST 5	IC Document
SORN NIST-5.docx SORN NIST 5	IC Document
10 CFR 20.1502 Citation.docx CFR 20.1502 citation	IC Document
10 CFR 20.1502 Citation.docx CFR 20.1502 citation	IC Document
Citation of § 20.2106.docx CFR 20.2106 citation	IC Document
Citation of § 20.2106.docx CFR 20.2106 citation	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 10 CFR 20.2106 10 CFR 20.1502

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	NIST-366A	Request for Personal Radiation Monitoring Services	Collection Instrument Form NIST-366a_updated.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title: NIST 5

FR Citation: 74 FR 50770

Number of Respondents: 600

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 50 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	600	600
Annual IC Time Burden (Hours)	150	150
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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