NRC Form 5, Occupational Dose Record for a Monitoring Period

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form NRC Form 5 NRC Form 5, Occupational Dose Record for a Monitoring Period	Form	Modified	Missing upstream
2023 Final Supporting Statement for NRC Form 5.docx	Supporting Statement A	Uploaded 2023-11-30	Missing upstream

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
33130	NRC Form 5, Occupational Dose Record for a Monitoring Period	Form	Modified

ICR Details

OMB Control No: 3150-0006	ICR Reference No: 202311-3150-006
Status: Received in OIRA	Previous ICR Reference No: 202008-3150-002
Agency/Subagency: NRC	Agency Tracking No:
Title: NRC Form 5, Occupational Dose Record for a Monitoring Period
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 12/01/2023

table that charts list comparision

	Requested	Previously Approved
Expiration Date	36 Months From Approved	01/31/2024
Responses	4,656	4,328
Time Burden (Hours)	109,060	106,906
Cost Burden (Dollars)	12,651	11,287

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Abstract: Form 5 is used to record and report the results of individual monitoring for occupational radiation exposure during a monitoring period (one calendar year) to ensure regulatory compliance with annual radiation dose limits specified in 10 CFR 20.1201.

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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 59949	08/30/2023
30-day Notice:	Federal Register Citation:	Citation Date:
	88 FR 83978	12/01/2023
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 5, Occupational Dose Record for a Monitoring Period	NRC Form 5, Not applicable	Occupational Dose Record for a Monitoring Period ,   REIRS and REMS File Submission Form

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ICR Summary of Burden

table that charts list of burden

	Total Request	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	4,656	4,328	0	0	328	0
Annual Time Burden (Hours)	109,060	106,906	0	0	2,154	0
Annual Cost Burden (Dollars)	12,651	11,287	0	0	1,364	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 increased by 2,154 hours from 106,906 hours to 109,060 hours. The majority of this change can be attributed to an inclusion of the burdens associated with reporting for materials licensees that voluntarily report to REIRS. The increase in reporting hours by materials licensees was mitigated by a decrease in the number of operating reactors and fewer monitored workers being annually reported. Additionally, there is a trend for materials licensees to be regulated under Agreement State agreements. When doing so, the licensee may choose to report to REIRS, but are not required to do so under NRC regulations. Based on experience and industry knowledge, the NRC anticipates that the number of monitored individuals during the upcoming clearance period will be similar to the data from 2021 used in these estimates. Additionally, the hourly fee rate increased from $278/hr to $290/hr.

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Annual Cost to Federal Government: $67,570

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: 12/01/2023

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