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OMB Control No: 3150-0005	ICR Reference No: 200903-3150-001
Status: Historical Active	Previous ICR Reference No: 200711-3150-005
Agency/Subagency: NRC	Agency Tracking No:
Title: NRC Form 4, Cumulative Occupational Exposure History
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 07/02/2009
	Date Received in OIRA: 03/04/2009
Terms of Clearance: Agency submitted additional 83-C explanation.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/28/2011	02/28/2011	02/28/2011
Responses	257	0	227
Time Burden (Hours)	64	0	43
Cost Burden (Dollars)	0	0	0

Abstract: NRC Form 4 is used to record the summary of an individual's cumulative occupational radiation dose up to and including the current year to ensure that the dose does not exceed regulatory limits.

Authorizing Statute(s): PL: Pub.L. 83 - 703 1-311 Name of Law: Atomic Energy Act

Citations for New Statutory Requirements: None

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
3150-AH40	Final or interim final rulemaking	71 FR 55382	09/22/2006

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	71 FR 55382	09/22/2006
Did the Agency receive public comments on this ICR? No

Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
NRC Form 4, Cumulative Occupational Exposure History	NRC Form 4

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Adjustment in Estimate
Annual Number of Responses	257	227	30
Annual Time Burden (Hours)	64	43	21
Annual Cost Burden (Dollars)	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: The Nuclear Regulatory Commission (NRC) amended its regulations to include jurisdiction over discrete sources of radium-226, accelerator-produced radioactive materials, and discrete sources of naturally occurring radioactive material, as required by the Energy Policy Act of 2005 (EPAct), which was signed into law on August 8, 2005. This provides a regulatory framework by which to license and regulate byproduct material in accordance with the new, expanded definition. The amended regulations impacted numerous existing information collections. The NRC packaged all of the impacted information collections into one new information collection which OMB approved and assigned control number 3150-0203. The clearance affecting this 83-C is NRC Form 4, Cumulative Occupational Exposure History, which is currently covered under OMB Clearance 3150-0005. This form is used by licensees to maintain a cumulative summary of personnel occupational exposure history. The purpose of this 83-C is to transfer burden from OMB Clearance 3150-0203, 10 CFR Parts 20, 30, 31, 32, & 35, Requirements for Expanded Definition of Byproduct Material, Final Rule and NRC Forms 4, 5, 313, 314, & 664, to OMB Clearance 3150-0005, Cumulative Occupational Exposure History, which was contained in the final approved on 8/23/07. Once the entire burden for 3150-0203 has been transferred to the correct clearances, we will submit an 83-D to discontinue 3150-0203. A total of 21 hours will be transferred to 3150-0005, resulting in a revised burden of 64 hours.

Annual Cost to Federal Government: $0

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

Agency Contact: Greg Trussell 301 415-6804 GRT1@nrc.gov

View ICR - OIRA Conclusion