Information Collection

Human Reliability Program

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

Documents and Forms

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:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	DOE F 470.3	Human Reliability Program (HRP) Certification	DOE F 470.3-HRP Certification.FINAL.1.pdf	Yes	Yes	Fillable Fileable
Form	DOE F 470.4	Acknowledgement and Agreement to Participate In The Human Reliability Program (HRP)	DOE F 470.4-Acknowledgment and Agreement To Participate In The Human Reliability Program (HRP).FINAL.pdf	Yes	Yes	Fillable Fileable
Form	DOE F 470.5	Authorization and Consent to Release Human Reliability Program (HRP)	DOE F 470.5-Authorization and Consent To Release Human Reliability Program (HRP) Records In Connection With HRP)_FINAL_pdf.pdf	Yes	Yes	Fillable Fileable
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	Yes	No	Fillable Fileable
Form	DOE F 470.12	Human Reliability Program (HRP) Alcohol Testing Form (LANL)	DOE F 470.12 HRP Alcohol Testing Form - LANL Use Only.pdf	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 %

	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

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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