Human Reliability Program

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form DOE F 470.12 Human Reliability Program (HRP) Alcohol Testing Form (LANL)	Form	Modified	Available
Form DOE F 470.7 Human Reliability Program (HRP) Alcohol Testing Form	Form	Modified	Available
Form DOE F 470.5 Authorization and Consent to Release Human Reliability Program (HRP)	Form	Modified	Available
Form DOE F 470.4 Acknowledgement and Agreement to Participate In The Human Reliability Program (HRP)	Form	Modified	Available
Form DOE F 470.3 Human Reliability Program (HRP) Certification	Form	Modified	Available
Form DOE F 470.3 Human Reliability Program	Form	Modified	Repair queued
1910-5122 Non Sub Change Request.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2025-08-06	Available
1910-5122 Non Sub Change Request.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2025-08-06	Repair queued
30- day FRN 12.05.22.pdf	Supplementary Document	Uploaded 2022-12-08	Available
30- day FRN 12.05.22.pdf	Supplementary Document	Uploaded 2022-12-08	Repair queued
1910-5122 Supporting Statement- Final_.docx	Supporting Statement A	Uploaded 2025-08-11	Repair queued
1910-5122 Supporting Statement- Final_.docx	Supporting Statement A	Uploaded 2025-08-11	Repair queued
60-day FRN 5-23-2022.pdf	Supplementary Document	Uploaded 2022-07-28	Available
60-day FRN 5-23-2022.pdf	Supplementary Document	Uploaded 2022-07-28	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
23449	Human Reliability Program	Form	Modified	Human Reliability Program (HRP) Alcohol Testing Form (LANL)
23449	Human Reliability Program	Form	Modified	Human Reliability Program (HRP) Alcohol Testing Form
23449	Human Reliability Program	Form	Modified	Authorization and Consent to Release Human Reliability Program (HRP)
23449	Human Reliability Program	Form	Modified	Acknowledgement and Agreement to Participate In The Human Reliability Program (HRP)
23449	Human Reliability Program	Form	Modified	Human Reliability Program (HRP) Certification
23449	Human Reliability Program	Form	Modified

ICR Details

OMB Control No: 1910-5122	ICR Reference No: 202507-1910-004
Status: Active	Previous ICR Reference No: 202407-1910-003
Agency/Subagency: DOE/DOEOA	Agency Tracking No: Baldev Dhillon
Title: Human Reliability Program
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 12/09/2025
Retrieve Notice of Action (NOA)	Date Received in OIRA: 08/11/2025
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2027	04/30/2027	04/30/2027
Responses	41,365	0	41,365
Time Burden (Hours)	4,610	0	4,610
Cost Burden (Dollars)	405,680	0	405,680

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Abstract: Collections are used by DOE management to certify to DOE that respondents were advised of the requirements for occupying or continuing to occupy a Human Reliability Program position.

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Authorizing Statute(s): US Code: 42 USC 7254 Name of Law: The Public Health and Welfare
   US Code: 42 USC 7256(a) Name of Law: The Public Health and Welfare
   PL: Pub.L. 95 - 91 August 4, 1977 Name of Law: Department of Energy Organization 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:
	87 FR 31222	05/23/2022
30-day Notice:	Federal Register Citation:	Citation Date:
	87 FR 74414	12/05/2022
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
Human Reliability Program	DOE F 470.3, DOE F 470.4, DOE F 470.7, DOE F 470.5, DOE F 470.12	Human Reliability Program (HRP) Certification ,   Acknowledgement and Agreement to Participate In The Human Reliability Program (HRP) ,   Authorization and Consent to Release Human Reliability Program (HRP) ,   Human Reliability Program (HRP) Alcohol Testing Form ,   Human Reliability Program (HRP) Alcohol Testing Form (LANL)

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ICR Summary of Burden

table that charts list of burden

	Total Approved	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	41,365	41,365	0	0	0	0
Annual Time Burden (Hours)	4,610	4,610	0	0	0	0
Annual Cost Burden (Dollars)	405,680	405,680	0	0	0	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:

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Annual Cost to Federal Government: $2,542

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: 08/11/2025

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