NRC Form 5, Occupational Exposure Record for a Monitoring Period

ICR 201706-3150-008 · OMB 3150-0006 · Historical Active

⚠️ Notice: This information collection may be outdated.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

Forms and Documents

Document	Type	Status	Availability
Form NRC Form 5 NRC Form 5, Occupational Exposure Record for a Monitoring Period	Form	Modified	Available
Final Supporting Statement_NRC Form 5_30day 7-3-17DCC (1).doc	Supporting Statement A	Uploaded 2017-07-24	Available

IC Document Collections

IC ID	Collection	Type	Status	Form
33130	NRC Form 5, Occupational Exposure Record for a Monitoring Period	Form	Modified

ICR Details

OMB Control No: 3150-0006	ICR Reference No: 201706-3150-008
Status: Historical Active	Previous ICR Reference No: 201405-3150-002
Agency/Subagency: NRC	Agency Tracking No:
Title: NRC Form 5, Occupational Exposure Record for a Monitoring Period
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 10/17/2017
Retrieve Notice of Action (NOA)	Date Received in OIRA: 08/01/2017
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2020	36 Months From Approved	10/31/2017
Responses	4,339	0	4,346
Time Burden (Hours)	125,373	0	130,852
Cost Burden (Dollars)	12,660	0	13,584

Abstract: NRC Form 5 is used to record and report the results of individual monitoring for occupational radiation exposure during a monitoring period (one calendar year) to ensure regulatory compliance with annual radiation dose limits specified in 10 CFR 20.1201.

Authorizing Statute(s): PL: Pub.L. 83 - 703 1-311 Name of Law: Atomic Energy Act

Citations for New Statutory Requirements: None

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 17044	04/07/2017
30-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 35556	07/31/2017
Did the Agency receive public comments on this ICR? No

Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
NRC Form 5, Occupational Exposure Record for a Monitoring Period	NRC Form 5	Occupational Dose Record for a Monitoring Period

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Adjustment in Estimate
Annual Number of Responses	4,339	4,346	-7
Annual Time Burden (Hours)	125,373	130,852	-5,479
Annual Cost Burden (Dollars)	12,660	13,584	-924

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: There was not a significant change in burden for this renewal. The burden decreased by 5,479 hours from 130,852 hours to 125,373 hours. This decrease is due to the number of operating reactor sites declining form 104 sites to 99 sites and there are fluctuations in the number of materials licensees

Annual Cost to Federal Government: $601,285

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination. No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination. No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

Agency Contact: Terry Brock 301 415-7000

Common Form ICR: No