NRC Form 366A Licensee Event Report Continuation Sheet

NRC FORM 366A

U.S. NUCLEAR REGULATORY COMMISSION

(MM-DD-YYYY)

LICENSEE EVENT REPORT (LER)
CONTINUATION SHEET
(See NUREG-1022, R.3 for instruction and guidance for completing this form
http://www.nrc.gov/reading-rm/doc-collections/nuregs/staff/sr1022/r3/)
1. FACILITY NAME

050
052
053

APPROVED BY OMB: NO. 3150-0104

EXPIRES: (MM/DD/YYYY)

Estimated burden per response to comply with this mandatory collection request: 80 hours. Reported
lessons learned are incorporated into the licensing process and fed back to industry. Send comments
regarding burden estimate to the FOIA, Library, and Information Collections Branch (T-6 A10M), U. S.
Nuclear Regulatory Commission, Washington, DC 20555-0001, or by email to
[email protected], and the OMB reviewer at: OMB Office of Information and Regulatory
Affairs, (3150-0104), Attn: Desk Officer for the Nuclear Regulatory Commission, 725 17th Street NW,
Washington, DC 20503. 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.

2. DOCKET NUMBER

3. LER NUMBER
SEQUENTIAL
NUMBER

YEAR

-

REV
NO.

-

NARRATIVE

NRC FORM 366A (MM-DD-YYYY)

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