Information Collection

NRC Form 4 (3150-0005 NRC Licensee RK Burden)

IC 44768 under ICR 200607-3150-006 · OMB 3150-0233.

Documents and Forms

Document Name Document Type
Form NRC Form 4 NRC Form 4 (3150-0005 NRC Licensee RK Burden) Form and Instruction
NRC Form 4 Cumulative Occupational Dose History Nrc4.pdf www.nrc.gov/reading-rm/doc-collections/forms/nrc4.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	NRC Form 4 (3150-0005 NRC Licensee RK Burden)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Mandatory

CFR Citation: 10 CFR 20

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 4	Cumulative Occupational Dose History	Nrc4.pdf	http://www.nrc.gov/reading-rm/doc-collections/forms/nrc4.pdf	No		Fillable Printable

Line of Business: Health

Subfunction:

Privacy Act System of Records
Title: NRC-27	FR Citation: 69 FR 57601

Number of Respondents: 6	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Program Change Due to New Statute
Annual Number of Responses for this IC	6	6
Annual IC Time Burden (Hours)	4	4
Annual IC Cost Burden (Dollars)	787	787

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.