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OMB Control No: 3150-0006	ICR Reference No: 200903-3150-002
Status: Historical Active	Previous ICR Reference No: 200708-3150-002
Agency/Subagency: NRC	Agency Tracking No:
Title: NRC Form 5, Occupational Exposure Record for a Monitoring Period
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: 07/04/2009
	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	11/30/2010	11/30/2010	11/30/2010
Responses	173,419	0	172,419
Time Burden (Hours)	66,649	0	65,618
Cost Burden (Dollars)	0	0	0

Abstract: NRC Form 5 is used to record and report the results of individual monitoring for occupational radiation exposure during a one-year (calendar year) period to ensure regulatory compliance with annual radiation dose 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:
	Not associated with rulemaking

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 25787	05/07/2007
30-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 43665	08/06/2007
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 5, Occupational Exposure Record for a Monitoring Period	NRC Form 5

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Adjustment in Estimate
Annual Number of Responses	173,419	172,419	1,000
Annual Time Burden (Hours)	66,649	65,618	1,031
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 5, Occupational Exposure Record for a Monitoring Period, which is currently covered under OMB Clearance 3150-0006. This form is used by licensees to record the occupational exposure of each individual monitored for radiation exposure at the licensed facility. 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 3150-0006, Occupational Exposure Record for a Monitoring Period, which was contained in the final approved on 8/23/07. NRC Form 5 is used by licensees to record the occupational exposure of each individual monitored for radiation exposure at the licensed facility. 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 1,031 hours will be transferred to 3150-0006, resulting in a revised total burden of 66,649 hours.

Annual Cost to Federal Government: $478,485

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