Information Collection

Form NIST-366A: Request for Personal Radiation Monitoring Services

IC 241904 under ICR 202608-0693-001 · OMB 0693-0086.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form NIST 366A Request for Personal Radiation Monitoring Services Form NIST-366A: Request for Personal Radiation Monitoring Services	Form
NIST 366A Request for Personal Radiation Monitoring Services Revised 366A form.pdf	Form
SORN NIST-5.docx SORN NIST 5	IC Document
10 CFR 20.1502 Citation.docx CFR 20.1502 citation	IC Document
Citation of § 20.2106.docx CFR 20.2106 citation	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 10 CFR 20.1502 10 CFR 20.2106

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	NIST 366A				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title: NIST 5

FR Citation: 74 FR 50770

Number of Respondents: 600

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 50 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	600	600
Annual IC Time Burden (Hours)	150	150
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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