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Federal forms, ICRs, and supporting documents

Information Collection Request

Certification of Medical Examination by Facility Licensee -- NRC Form 396

ICR 199610-3150-001 · OMB 3150-0024 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC IDCollectionTypeStatusForm
33227 Certification of Medical Examination by Facility Licensee -- NRC Form 396 Form Migrated
ICR Details
3150-0024 199610-3150-001
Historical Active 199310-3150-001
NRC
Certification of Medical Examination by Facility Licensee -- NRC Form 396
Revision of a currently approved collection   No
Regular
Approved without change 12/06/1996
Retrieve Notice of Action (NOA) 10/10/1996
  Inventory as of this Action Requested Previously Approved
01/31/2000 01/31/2000 12/31/1996
975 0 1,700
741 0 925
0 0 0
NRC form 396 establishes the procedure for transmitting information to the NRC regarding the medical condition of applications for initial or renewal operator licenses and for the maintenance of medical records for all licensed operations.
None
None
No
1
IC Title Form No. Form Name
Certification of Medical Examination by Facility Licensee -- NRC Form 396 396
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 975 1,700 0 0 -725 0
Annual Time Burden (Hours) 741 925 0 0 -184 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected
  No
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
10/10/1996