Information Collection

NRC Form 396, "Certification of Medical Examination by Facility Licensee"

IC 279131 under ICR 202604-3150-004 · OMB 3150-0277.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form NRC Form 396 Certification of Medical Examination by Facility Licensee NRC Form 396, "Certification of Medical Examination by Facility Licensee"	Form and Instruction
NRC Form 396 Certification of Medical Examination by Facility License NRC Form 396 - Certification of Medical Examination (Part 53 Rulemaking).pdf	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Mandatory

CFR Citation: 10 CFR 53

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 and Instruction	NRC Form 396				Yes	Yes	Fillable Fileable

Line of Business: Energy

Subfunction: Energy Production

Privacy Act System of Records

Title: Facility Operator Licensee Records

FR Citation: 87 FR 71536

Number of Respondents: 2

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	Program Change Due to New Statute
Annual Number of Responses for this IC	17	17
Annual IC Time Burden (Hours)	21	21
Annual IC Cost Burden (Dollars)	0	0

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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