NRC Form 396, Certification of Medical Examination by Facility Licensee

ICR 201707-3150-006 · OMB 3150-0024 · Historical Active

⚠️ Notice: This information collection may be outdated. More recent filings for OMB 3150-0024 can be found here:

Forms and Documents

Document	Type	Status	Availability
Form Form 396 NRC Form 396, Certification of Medical Examination by Facility Licensee	Form and Instruction	Modified	Available
NRC form 396 nonsubstantive change request - final (1).docx	Justification for No Material/Nonsubstantive Change	Uploaded 2017-07-26	Available

IC Document Collections

IC ID	Collection	Type	Status	Form
33230	NRC Form 396, Certification of Medical Examination by Facility Licensee	Form and Instruction	Modified

ICR Details

OMB Control No: 3150-0024	ICR Reference No: 201707-3150-006
Status: Historical Active	Previous ICR Reference No: 201501-3150-009
Agency/Subagency: NRC	Agency Tracking No:
Title: NRC Form 396, Certification of Medical Examination by Facility Licensee
Type of Information Collection: No material or nonsubstantive change to 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: 07/26/2017
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2019	03/31/2019	03/31/2019
Responses	2,131	0	2,131
Time Burden (Hours)	1,968	0	1,968
Cost Burden (Dollars)	0	0	0

Abstract: 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.

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:
	79 FR 61105	10/09/2014
30-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 3993	01/26/2015
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 396, Certification of Medical Examination by Facility Licensee	Form 396	Certification of Medical Examanation by Facility Licensee

ICR Summary of Burden

	Total Approved	Previously Approved
Annual Number of Responses	2,131	2,131
Annual Time Burden (Hours)	1,968	1,968
Annual Cost Burden (Dollars)	0	0

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:

Annual Cost to Federal Government: $188,000

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: Angela Baxter 301 415-1065

Common Form ICR: No