OMB control number

NRC Form 5, Occupational Dose Record for a Monitoring Period

OMB 3150-0006 · NRC.

OMB 3150-0006

Form 5 is used to record and report the results of individual monitoring for occupational radiation exposure during a monitoring period (one calendar year) to ensure regulatory compliance with annual radiation dose limits specified in 10 CFR 20.1201.

The latest form for NRC Form 5, Occupational Dose Record for a Monitoring Period expires 2027-11-30 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form NRC Form 5 NRC Form 5, Occupational Dose Record for a Monitoring Period Form
2023 Final Supporting Statement for NRC Form 5.docx Supporting Statement A
NRC Form 5, Occupational Dose Record for a Monitoring Period Form

All Historical Document Collections

202311-3150-006	Extension without change of a currently approved collection	2023-12-01
202008-3150-002 Approved without change	Extension without change of a currently approved collection	2020-08-19
201706-3150-008 Approved without change	Extension without change of a currently approved collection	2017-08-01
201405-3150-002 Approved without change	Revision of a currently approved collection	2014-05-29
201006-3150-009 Approved without change	Revision of a currently approved collection	2010-10-28
200903-3150-002 Approved with change	No material or nonsubstantive change to a currently approved collection	2009-03-04
200708-3150-002 Approved without change	Revision of a currently approved collection	2007-08-15
200408-3150-003 Approved without change	Revision of a currently approved collection	2004-08-13
200107-3150-006 Approved without change	Revision of a currently approved collection	2001-07-30
199807-3150-006 Approved without change	Revision of a currently approved collection	1998-07-15
199506-3150-004 Approved without change	Extension without change of a currently approved collection	1995-06-23
199207-3150-008 Approved without change	Revision of a currently approved collection	1992-07-16
199106-3150-004 Approved without change	Reinstatement with change of a previously approved collection	1991-06-26
198906-3150-004 Approved without change	Revision of a currently approved collection	1989-06-01
198605-3150-001 Approved without change	Reinstatement with change of a previously approved collection	1986-05-07
198512-3150-001 Approved without change	Revision of a currently approved collection	1985-12-12
198509-3150-002 Withdrawn and continue	Revision of a currently approved collection	1985-09-16
198304-3150-004 Approved without change	Revision of a currently approved collection	1983-04-08
198104-3150-006 Approved without change	Revision of a currently approved collection	1981-04-01