Information Collection

NRC Form 893, "Single FFD Policy Violation Form," and NRC Form 894, "Annual Reporting Form for FFD Information"

IC 271952 under ICR 202410-3150-013 · OMB 3150-0272.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3150-0272 can be found here:

Documents and Forms

Document Name Document Type
Form NRC Form 893 NRC Form 893, "Single FFD Policy Violation Form," and NRC Form 894, "Annual Reporting Form for FFD Information" Form
DG-5073 - Fitness-For-Duty Programs For Commercial Nuclear Plants And Manufacturing Facilities Licensed Under 10 CFR Part 53.doc Instruction
NRC Form 893 Part 26 Subpart M Single FFD Policy Violation Form NRC Form 893, Part 26 Subpart M Single FFD Policy Violation Form.pdf Form
NRC Form 894 Part 26 Subpart M, Annual Reporting Form for FFD Perform NRC Form 894, Part 26 Subpart M, Annual Reporting Form for FFD Performance Information.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	NRC Form 893, "Single FFD Policy Violation Form," and NRC Form 894, "Annual Reporting Form for FFD Information"	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Mandatory

CFR Citation: 10 CFR 26

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	NRC Form 893	Part 26 Subpart M Single FFD Policy Violation Form	NRC Form 893, Part 26 Subpart M Single FFD Policy Violation Form.pdf	Yes	Yes	Fillable Fileable
Form	NRC Form 894	Part 26 Subpart M, Annual Reporting Form for FFD Performance Information	NRC Form 894, Part 26 Subpart M, Annual Reporting Form for FFD Performance Information.pdf	Yes	Yes	Fillable Fileable
Instruction			DG-5073 - Fitness-For-Duty Programs For Commercial Nuclear Plants And Manufacturing Facilities Licensed Under 10 CFR Part 53.docx	Yes	Yes	Fillable Fileable

Line of Business: Energy

Subfunction: Energy Resource Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Program Change Due to New Statute
Annual Number of Responses for this IC	1	1
Annual IC Time Burden (Hours)	1	1
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.