Information Collection

Human Reliability Program

IC 23449 under ICR 202507-1910-004 · OMB 1910-5122.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form DOE F 470.3 Human Reliability Program	Form
Form DOE F 470.3 Human Reliability Program (HRP) Certification Human Reliability Program	Form
Form DOE F 470.4 Acknowledgement and Agreement to Participate In The Human Reliability Program (HRP) Human Reliability Program	Form
Form DOE F 470.5 Authorization and Consent to Release Human Reliability Program (HRP) Human Reliability Program	Form
Form DOE F 470.7 Human Reliability Program (HRP) Alcohol Testing Form Human Reliability Program	Form
Form DOE F 470.12 Human Reliability Program (HRP) Alcohol Testing Form (LANL) Human Reliability Program	Form
DOE F 470.3 Human Reliability Program (HRP) Certification DOE F 470.3-HRP Certification.FINAL.1.pdf	Form
DOE F 470.3 Human Reliability Program (HRP) Certification DOE F 470.3-HRP Certification.FINAL.1.pdf	Form
DOE F 470.4 Acknowledgement and Agreement to Participate In The Huma DOE F 470.4-Acknowledgment and Agreement To Participate In The Human Reliability Program (HRP).FINAL.pdf	Form
DOE F 470.4 Acknowledgement and Agreement to Participate In The Huma DOE F 470.4-Acknowledgment and Agreement To Participate In The Human Reliability Program (HRP).FINAL.pdf	Form
DOE F 470.5 Authorization and Consent to Release Human Reliability P DOE F 470.5-Authorization and Consent To Release Human Reliability Program (HRP) Records In Connection With HRP)_FINAL_pdf.pdf	Form
DOE F 470.5 Authorization and Consent to Release Human Reliability P DOE F 470.5-Authorization and Consent To Release Human Reliability Program (HRP) Records In Connection With HRP)_FINAL_pdf.pdf	Form
DOE F 470.7 Human Reliability Program (HRP) Alcohol Testing Form DOE F 470.7-Human Reliability Program (HRP) Alcohol Testing Form.FINAL.pdf	Form
DOE F 470.7 Human Reliability Program (HRP) Alcohol Testing Form DOE F 470.7-Human Reliability Program (HRP) Alcohol Testing Form.FINAL.pdf	Form
DOE F 470.12 Human Reliability Program (HRP) Alcohol Testing Form (LA DOE F 470.12 HRP Alcohol Testing Form - LANL Use Only.pdf	Form
DOE F 470.12 Human Reliability Program (HRP) Alcohol Testing Form (LA DOE F 470.12 HRP Alcohol Testing Form - LANL Use Only.pdf	Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Human Reliability Program

Agency IC Tracking Number:

Baldev Dhillon

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 10 CFR 712

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	DOE F 470.3	Yes	Yes	Fillable Fileable
Form	DOE F 470.4	Yes	Yes	Fillable Fileable
Form	DOE F 470.5	Yes	Yes	Fillable Fileable
Form	DOE F 470.7	Yes	No	Fillable Fileable
Form	DOE F 470.12	Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 41,321

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	41,365	41,365
Annual IC Time Burden (Hours)	4,610	4,610
Annual IC Cost Burden (Dollars)	405,680	405,680

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.

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