Information Collection

Dosimetry Application and Record of Previous Radiation Exposure

IC 247663 under ICR 202405-0702-002 · OMB 0702-0150.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form DD 1952 Dosimetry Application and Record of Previous Radiation Exposure	Form
DD 1952 Dosimetry Application and Record of Previous Radiation E DD1952 DRAFT 20210817.pdf	Form
DD 1952 Dosimetry Application and Record of Previous Radiation E DD1952 DRAFT 20210817.pdf	Form

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

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	DD 1952	Dosimetry Application and Record of Previous Radiation Exposure	DD1952 DRAFT 20210817.pdf		Yes	Yes	Fillable Fileable Signable

Line of Business: Defense and National Security

Subfunction: Operational Defense

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 25

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 80 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	25	0	25
Annual IC Time Burden (Hours)	6	0	6
Annual IC Cost Burden (Dollars)	219	32	187

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.