Information Collection

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

IC 279131 under ICR 202604-3150-004 · OMB 3150-0277.

Documents and Forms

Document Name Document Type
Form NRC Form 396 Certification of Medical Examination by Facility Licensee NRC Form 396, "Certification of Medical Examination by Facility Licensee" Form and Instruction
NRC Form 396 Certification of Medical Examination by Facility License NRC Form 396 - Certification of Medical Examination (Part 53 Rulemaking).pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

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
Form and Instruction	NRC Form 396	Certification of Medical Examination by Facility Licensee	NRC Form 396 - Certification of Medical Examination (Part 53 Rulemaking).pdf		Yes	Yes	Fillable Fileable

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

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.

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