Information Collection

NRC Form 5 (3150-0006 Agreement State Licensees)

IC 181281 under ICR 200805-3150-002 · OMB 3150-0203.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3150-0203 can be found here:

Documents and Forms

Document Name Document Type
Form NRC Form 5 NRC Form 5 (3150-0006 Agreement State Licensees) Form and Instruction
NRC Form 5 Occupational Dose Record For A Monitoring Period nrc5.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	NRC Form 5 (3150-0006 Agreement State Licensees)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

Obligation to Respond: Mandatory

CFR Citation: 10 CFR 20

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	NRC Form 5	Occupational Dose Record For A Monitoring Period	nrc5.pdf		No		Fillable Printable

Line of Business: Energy

Subfunction: Energy Resource Management

Privacy Act System of Records
Title: NRC-27	FR Citation: 69 FR 57601

Number of Respondents: 800	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	800	800
Annual IC Time Burden (Hours)	825	825
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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