Information Collection

NRC Form 5, Occupational Dose Record for a Monitoring Period

IC 33130 under ICR 202311-3150-006 · OMB 3150-0006.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form NRC Form 5 NRC Form 5, Occupational Dose Record for a Monitoring Period	Form
NRC Form 5 Occupational Dose Record for a Monitoring Period NRC 5 (OMB Copy).pdf	Form
Not applicable REIRS and REMS File Submission Form REIRS and REMS File Submission Form 4-27-23.pdf	Form

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 10 CFR 20

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	NRC Form 5	Occupational Dose Record for a Monitoring Period	NRC 5 (OMB Copy).pdf		Yes	Yes	Fillable Fileable
Form	Not applicable	REIRS and REMS File Submission Form	REIRS and REMS File Submission Form 4-27-23.pdf		Yes	Yes	Fillable Fileable

Line of Business: Energy

Subfunction: Energy Resource Management

Privacy Act System of Records

Title: NRC 27, Radiation Exposure Information and Reporting System (REIRS) Records

FR Citation: 84 FR 71536

Number of Respondents: 4,404

Number of Respondents for Small Entity: 124

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 96 %

table that charts list of burden
	Requested	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	4,656	328	4,328
Annual IC Time Burden (Hours)	109,060	2,154	106,906
Annual IC Cost Burden (Dollars)	12,651	1,364	11,287

Documents for IC

table that charts IC Documents
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.