NRC Form 4, Cumulative Occupational Dose History

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form Not applicable REIRS Automated Dose History Request Form	Form and Instruction	Modified	Repair queued
Form NRC Form 4 Cumulative Occupational Dose History	Form and Instruction	Modified	Available
Form NRC Form 4 NRC Form 4, Cumulative Occupational Dose History	Form and Instruction	Modified	Repair queued
2023 Final Supporting Statement NRC Form 4.docx	Supporting Statement A	Uploaded 2023-11-17	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
33127	NRC Form 4, Cumulative Occupational Dose History	Form and Instruction	Modified	REIRS Automated Dose History Request Form
33127	NRC Form 4, Cumulative Occupational Dose History	Form and Instruction	Modified	Cumulative Occupational Dose History
33127	NRC Form 4, Cumulative Occupational Dose History	Form and Instruction	Modified

ICR Details

OMB Control No: 3150-0005	ICR Reference No: 202311-3150-004
Status: Active	Previous ICR Reference No: 202007-3150-005
Agency/Subagency: NRC	Agency Tracking No:
Title: NRC Form 4, Cumulative Occupational Dose History
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 07/30/2024
Retrieve Notice of Action (NOA)	Date Received in OIRA: 11/21/2023
Terms of Clearance: In accordance with 5 CFR 1320, this information collection is approved for 3 years.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2027	36 Months From Approved	07/31/2024
Responses	243,429	0	241,014
Time Burden (Hours)	66,558	0	65,954
Cost Burden (Dollars)	6,877	0	6,533

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Abstract: The NRC Form 4 is used to record the summary of an occupational worker’s cumulative occupational radiation dose, including prior occupational exposure and the current year’s occupational radiation exposure. The NRC Form 4 is used by licensees, and inspected by the NRC, to ensure that occupational radiation doses do not exceed the regulatory limits specified in 10 CFR 20.1501.

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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:
	88 FR 59951	08/30/2023
30-day Notice:	Federal Register Citation:	Citation Date:
	88 FR 81112	11/21/2023
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 4, Cumulative Occupational Dose History	NRC Form 4, Not applicable	Cumulative Occupational Dose History ,   REIRS Automated Dose History Request 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	243,429	241,014	0	0	2,415	0
Annual Time Burden (Hours)	66,558	65,954	0	0	604	0
Annual Cost Burden (Dollars)	6,877	6,533	0	0	344	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 estimated burden has increased by 604 hours from the previous burden of 65,954 hours to 66,558 hours. The burden increase is primarily due an increase in respondents that are not subject to 10 CFR 20.2206(a) but must still maintain these records using an NRC Form 4 or equivalent. The number of licensees that fall in this category and report to REIRS may vary from year to year and was 9,860 responses higher compared to the previous renewal in 2020. This led to a 539-hour increase in recordkeeping and a 64-hour increase in third party disclosure burden estimates. The recordkeeping burden increased from 58,747 hours to 59,286 hours, mainly due to the higher number of non-material licensees reporting. It should be noted that the NRC does not anticipate any planned special exposures during the next three years. Additional costs associated with records storage have increased from $6,533 to $6,877 (an increase of $344) due to an increase in the fee rate used to calculate the costs. The fee rate has increased from $278 to $290 per hour. Because the recordkeeping burden is estimated to be 59,286 hours, the storage cost for this clearance is $ 6,877 (59,286 hours x 0.0004 x $290/h).

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Annual Cost to Federal Government: $151,960

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: 11/21/2023

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