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Information Collection Request

NRC Form 5, Occupational Exposure Record for a Monitoring Period

ICR 200107-3150-006 · OMB 3150-0006 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC IDCollectionTypeStatusForm
33129 NRC Form 5, Occupational Exposure Record for a Monitoring Period Form Migrated
ICR Details
3150-0006 200107-3150-006
Historical Active 199807-3150-006
NRC
NRC Form 5, Occupational Exposure Record for a Monitoring Period
Revision of a currently approved collection   No
Regular
Approved without change 10/15/2001
Retrieve Notice of Action (NOA) 07/30/2001
  Inventory as of this Action Requested Previously Approved
10/31/2004 10/31/2004 10/31/2001
370,212 0 671,171
66,682 0 175,957
0 0 0
NRC Form 5 is used to record and annually report the results of individual monitoring for occupational exposure to radiation during a one-year period to ensure compliance with annual occupational exposure limits.
None
None
No
1
IC Title Form No. Form Name
NRC Form 5, Occupational Exposure Record for a Monitoring Period NRC-FORM5
  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 370,212 671,171 0 -16,368 -284,591 0
Annual Time Burden (Hours) 66,682 175,957 0 -5,943 -103,332 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
Yes
$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.
07/30/2001