Information Collection Request

NRC Form 396, Certification of Medical Examination by Facility Licensee

ICR 202512-3150-001 · OMB 3150-0024 · Active

IC Document Collections
IC IDCollectionTypeStatusForm
33230 NRC Form 396, Certification of Medical Examination by Facility Licensee Form and Instruction ModifiedFORM 396 -CERTIFICATION OF MEDICAL EXAMINATION BY FACILITY LICENSEE
33230 NRC Form 396, Certification of Medical Examination by Facility Licensee Form and Instruction ModifiedONLINE FORM -CERTIFICATION OF MEDICAL EXAMINATION BY FACILITY LICENSEE
33230 NRC Form 396, Certification of Medical Examination by Facility Licensee Form and Instruction Modified
ICR Details
3150-0024 202512-3150-001
Active 202303-3150-002
NRC
NRC Form 396, Certification of Medical Examination by Facility Licensee
Extension without change of a currently approved collection   No
Regular
Approved without change 04/15/2026
Retrieve Notice of Action (NOA) 12/23/2025
In accordance with 5 CFR 1320, the information collection is approved. Please consider the options contemplated in public comments to maximize the practical utility of the collection and minimize the burden including efforts that may include a future rulemaking.
  Inventory as of this Action Requested Previously Approved
04/30/2029 36 Months From Approved 04/30/2026
1,862 0 1,778
2,161 0 2,063
55 0 48

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

  90 FR 42626 09/03/2025
90 FR 60130 12/23/2025
Yes

  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 1,862 1,778 0 0 84 0
Annual Time Burden (Hours) 2,161 2,063 0 0 98 0
Annual Cost Burden (Dollars) 55 48 0 0 7 0
No
No
The number of total responses has increased from 1,778 in the prior cycle to 1,862 in this cycle. NRC Form 396 is the mechanism by which NRC is advised of the applicant/operator general health and physical condition, and when a facility and/or individual is no longer subject to the requirements of 10 CFR Part 55, they will no longer submit NRC Form 396. Therefore, the increase in projected submissions is due to the increase in licensed individuals, operating reactor plants, and projected license renewals being subject to Part 55 requirements. Currently, NRC uses the Electronic Information Exchange (EIE), OSM, facsimile, or e‑mail to deliver NRC Form 396 and receive the completed medical reviews from the NRC Contractor. The facility licensees submit a scanned pdf version of NRC Form 396 via EIE. NRC Form 396 was updated to clarify instructions. In addition, the fee rate has increased from $288 to $317 per hour

$200,693
No
    No
    No
No
No
No
No
Ikeda Betts 301 415-1959

  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.
12/23/2025