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Federal forms, ICRs, and supporting documents

Information Collection Request

NRC Form 396, Certification of Medical Examination by Facility Licensee

ICR 200810-3150-003 · OMB 3150-0024 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Form 396 NRC Form 396, Certification of Medical Examination by Facility Licensee Form and Instruction Modified Available
FinalSupporting Statement NRC Form 396 04-17-09.doc Supporting Statement A Uploaded 2009-04-17 Available
IC Document Collections
IC IDCollectionTypeStatusForm
33230 NRC Form 396, Certification of Medical Examination by Facility Licensee Form and Instruction Modified
ICR Details
3150-0024 200810-3150-003
Historical Active 200511-3150-002
NRC
NRC Form 396, Certification of Medical Examination by Facility Licensee
Revision of a currently approved collection   No
Regular
Approved with change 04/17/2009
Retrieve Notice of Action (NOA) 12/04/2008
Corrections made to Supporting Statement and in ROCIS.
  Inventory as of this Action Requested Previously Approved
04/30/2012 36 Months From Approved 04/30/2009
1,427 0 1,287
789 0 758
0 0 0
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.
PL: Pub.L. 83 - 703 1-311 Name of Law: Atomic Energy Act
  
None
Not associated with rulemaking
  73 FR 45083 08/01/2008
73 FR 65685 11/04/2008
No
  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 1,427 1,287 0 0 140 0
Annual Time Burden (Hours) 789 758 0 0 31 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
The overall burden increased by 35 hours from 758 to 789 hours because of the following: the number of new applicants increased by 75 from 475 to 550, thereby increasing the burden by 18.75 hours; the number of renewals increased by 50 from 600 to 650, thereby increasing the burden by 12.50 hours, and the number of notices of disability increased by 15 from 75 to 90, thereby increasing the burden by 3.75 hours. There has been an increase in the overall cost as a result of an increase in the rate from $205/hr to $238/hr.
$70,199
No
No
Uncollected
Uncollected
No
Uncollected
Carole Revelle 3014151065
  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.
12/04/2008