Information Collection

NRC Form 396, "Certification of Medical Examination by Facility Licensee"

IC 279131 under ICR 202602-3150-011 · OMB unassigned.

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Information Collection (IC) Details

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IC Title:	NRC Form 396, "Certification of Medical Examination by Facility Licensee"	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Mandatory

CFR Citation: 10 CFR 53

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Line of Business: Energy

Subfunction: Energy Production

Privacy Act System of Records
Title: Facility Operator Licensee Records	FR Citation: 87 FR 71536

Number of Respondents: 2	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to New Statute
Annual Number of Responses for this IC	17	17
Annual IC Time Burden (Hours)	21	21
Annual IC Cost Burden (Dollars)	0	0

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Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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