NRC Form 755 Advance Notification of Shipment of Category 1 Quantitie

NRC FORM 755

(MM-YYYY)
10 CFR 37.77(b)

U.S. NUCLEAR REGULATORY COMMISSION

ADVANCE NOTIFICATION TO THE
NRC OF SHIPMENTS OF
CATEGORY 1 QUANTITIES OF
RADIOACTIVE MATERIAL

Notification Date:

EXPIRES: (MM/DD/YYYY)

APPROVED BY OMB: NO. 3150-0214

Estimated burden per response to comply with this collection request: 8 minutes. This form is a voluntary means of fulfilling the
requirements in 10 CFR 37.77. The information provided will be used to meet the requirement in 10 CFR 37.77 for licensees to
submit advance notification of shipment of Category 1 quantities of radioactive material to NRC and States. The notification to
governors allows States to be aware of shipments in their jurisdictions, to provide escorts if they consider them necessary, and to
respond to any incidents that require a State response. The notification to the NRC provides information that allows the NRC and
other Federal agencies to respond in the event of an incident. NRC may share this information with other government agencies
to ensure security. Send comments regarding burden estimate to the Information Services Branch (T-6 A10M), U.S. Nuclear
Regulatory Commission, Washington, DC 20555-0001, or by e-mail to [email protected], and the OMB reviewer at:
OMB Office of Information and Regulatory Affairs, (3150-0214), Attn: Desk Officer for the Nuclear Regulatory Commission, 725
17th Street NW, Washington, DC 20503; e-mail: [email protected]. The NRC may not conduct or sponsor, and a
person is not required to respond to, a collection of information unless the document requesting or requiring the collection
displays a currently valid OMB control number.

Shipping Identification: (Unique identifier)

Notification Revision Number:

SHIPPER INFORMATION:
Name of Shipper*:

Name of Shipper's Point of Contact*:

Shipper's Address*: (Include City, state, and zip code)

Telephone Number for Point of Contact*: (Include area code)

Type of Shipment:

Shipper's License Number*: (Include Import, export, or transshipment, when applicable)
Domestic

Export

Import

Transshipment

POINT OF ORIGIN INFORMATION:
Point of Origin Address*: (Include city, state, and zip code)

Contact Name:

Telephone Number for Contact: (Include area code)

RECIPIENT (Consignee) INFORMATION:
Name of Consignee*:

Name of Consignee's Point of Contact:

Consignee's Address*: (Include City, state, and zip code)

Telephone Number for Consignee Contact: (Include area code)

Recipient's (consignee) License Number*:

Radioactive Isotope*:

Estimated Activity*: (Preferably in terabecquerel)

Description of Shipment*: (e.g., physical form and number of sources or flasks or containers)

END USE OF SHIPMENT:
Name of Carrier(s)*:

Name of Carrier(s) Point of Contact:

Carrier(s) Address:*(Include City, state, and zip code)

Telephone Number for Carrier(s) Contact*: (Include area code)

NRC FORM 755 (MM-YYYY)

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U.S. NUCLEAR REGULATORY COMMISSION

NRC FORM 755

(MM-YYYY)
10 CFR 37.77(b)

ADVANCE NOTIFICATION TO THE NRC OF SHIPMENTS OF CATEGORY 1
QUANTITIES OF RADIOACTIVE MATERIAL (Continued)

Planned Departure Date and Time of Shipment*
Date:

Time:

Actual Confirmed Departure Date and Time of Shipment*
Date:

Planned Date and Time of Shipment Arrival
Date:

Time:

Time:

Actual Confirmed Date and Time of Shipment Arrival
Date:

Time:

Routing Information:

Mode(s) of Transportation:

Estimated Time and Date that Shipment is Expected to Enter Each State Along the Route*:

For Import/Exports Include Point of U.S. Entry or Departure*:

Point of Contact, with Telephone Number for Current Shipment Information*:

*This symbol indicates that the information is required by 10 CFR 37.77(b). The other items are voluntary but are requested by the
U.S. Nuclear Regulatory Commission (NRC) to enable it to provide more accurate and detailed information for any emergency
response.
Note that the preferred notification method to the NRC is through the Operations Center by e-mail or facsimile at least 4 days before
the scheduled shipping date. The notification to the NRC may be made by e-mail to [email protected] or by fax to (301)
816-5151. Shippers should coordinate with States as indicated in 10 CFR 37.77(a). The NRC requests that the shipper also notify the
agency with a confirmation of the departure date within 1 day after the actual shipment departure and with a confirmation of the
arrival date within 1 day after the actual arrival.
Under 10 CFR 37.77(c)(1), any change in the shipment information supplied above must be provided to the States and the NRC as
soon as the information becomes available but before the commencement of the shipment. Under 10 CFR 37.77(c)(2), notification of
changes to the shipment schedule while the shipment is in transit must be made immediately to the NRC Operations Center and the
appropriate States.
NRC FORM 755 (MM-YYYY)

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