Information Collection

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

IC 33227 under ICR 199610-3150-001 · OMB 3150-0024.

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Information Collection (IC) Details

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IC Title:	Certification of Medical Examination by Facility Licensee -- NRC Form 396	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	396				No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 975	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	975	-725	1,700
Annual IC Time Burden (Hours)	741	-184	925
Annual IC Cost Burden (Dollars)	0	0	0

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