NRC Form 396, Certification of Medical Examination by Facility Licensee

OMB 3150-0024

NRC Form 396 is used to transmit information to the NRC regarding the medical condition of applicants for initial operator licenses or renewal of operator licenses and for the maintenance of medical records for all licensed operators. The information is used to determine whether the physical condition and general health of applicants for operator licensees is such that the applicant would not be expected to cause operational errors and endanger public health and safety.

The latest form for NRC Form 396, Certification of Medical Examination by Facility Licensee expires 2022-09-30 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form NRC Form 396 NRC Form 396, Certification of Medical Examination by Facility Licensee Form and Instruction
Nonsubstantive Change Request for Form 396 (Instructions).docx Justification for No Material/Nonsubstantive Change
NRC Form 396, Certification of Medical Examination by Facility Licensee Form and Instruction

All Historical Document Collections

202303-3150-002 Approved with change	No material or nonsubstantive change to a currently approved collection	2023-03-20
202205-3150-006 Approved with change	Extension without change of a currently approved collection	2022-06-01
201902-3150-003 Approved with change	Extension without change of a currently approved collection	2019-03-05
201707-3150-006 Approved without change	No material or nonsubstantive change to a currently approved collection	2017-07-26
201501-3150-009 Approved with change	Extension without change of a currently approved collection	2015-02-04
201203-3150-001 Approved without change	Extension without change of a currently approved collection	2012-03-15
200810-3150-003 Approved with change	Revision of a currently approved collection	2008-12-04
200511-3150-002 Approved without change	Revision of a currently approved collection	2005-11-10
200211-3150-001 Approved without change	Revision of a currently approved collection	2002-11-08
199910-3150-003 Approved without change	Revision of a currently approved collection	1999-10-25
199610-3150-001 Approved without change	Revision of a currently approved collection	1996-10-10
199310-3150-001 Approved without change	Revision of a currently approved collection	1993-10-15
199107-3150-006 Approved with change	No material or nonsubstantive change to a currently approved collection	1991-07-17
199012-3150-001 Approved without change	Revision of a currently approved collection	1990-12-17
198905-3150-004 Approved with change	No material or nonsubstantive change to a currently approved collection	1989-05-03
198802-3150-004 Approved without change	Reinstatement with change of a previously approved collection	1988-02-26
198411-3150-004 Approved without change	Revision of a currently approved collection	1984-11-26
198205-3150-001 Approved without change	Revision of a currently approved collection	1982-05-14
198104-3150-023 Approved without change	Revision of a currently approved collection	1981-04-01