Information Collection

NRC Form 5, Occupational Exposure Record for a Monitoring Period

IC 33130 under ICR 201405-3150-002 · OMB 3150-0006.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3150-0006 can be found here:

Documents and Forms

Document Name Document Type
Form NRC Form 5 NRC Form 5, Occupational Exposure Record for a Monitoring Period Form
NRC Form 5 Occupational Dose Record for a Monitoring Period NRC 5 (MM-DD-YYYY) (PS).pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	NRC Form 5, Occupational Exposure Record for a Monitoring Period	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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	NRC Form 5	Occupational Dose Record for a Monitoring Period	NRC 5 (MM-DD-YYYY) (PS).pdf		Yes	Yes	Fillable Printable

Line of Business: Energy

Subfunction: Energy Resource Management

Privacy Act System of Records
Title: NRC 27, Radiation Exposure Information and Reporting System (REIRS) Records	FR Citation: 77 FR 67204

Number of Respondents: 4,146	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 99 %

	Approved	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	4,346	0	304	4,042
Annual IC Time Burden (Hours)	130,852	53,816	8,480	68,556
Annual IC Cost Burden (Dollars)	13,584	0	13,584	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.