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Category:NRC Forms (Blank)
MONTHYEARML22192A1972022-07-11011 July 2022 NRC Form 446 - Request for Approval of Official Foreign Travel by Non-Government Personnel (*Must Be Completed 30 Days Prior to Travel) ML21148A2422021-05-28028 May 2021 NRC Form 149 - Ocfo Invitational Traveler Request Form ML20339A6732021-01-12012 January 2021 NRC Form 529 - Dispute of Fees-for-Service Charges in Accordance with Title 10 of the Code of Federal Regulations (10 CFR) 170.51 ML12164A7272020-01-31031 January 2020 NRC Form 313A (Amp), Authorized Medical Physicist or Ophthalmic Physicist, Training, Experience and Preceptor Attestation (10 CFR 35.51, 35.57(a)(3), and 35.433). (01-2020) ML12164A7282020-01-31031 January 2020 NRC Form 313A (Anp), Authorized Nuclear Pharmacist Training, Experience, and Preceptor Attestation (10 CFR 35.55). (01-2020) ML12164A7332020-01-31031 January 2020 NRC Form 313A (Aud), Authorized User Training, Experience, and Preceptor Attestation (for Uses Defined Under 35.100, 35.200, and 35.500) (10 CFR 35.57, 35.190, 35.290, and 35.590). (01-2020) ML12164A7362020-01-31031 January 2020 NRC Form 313A (Aus), Authorized User Training, Experience, and Preceptor Attestation (for Uses Defined Under 35.400 and 35.600) (10 CFR 35.57, 35.490, 35.491, and 35.690). (01-2020) ML12164A7412020-01-31031 January 2020 NRC Form 313A (Aut), Authorized User Training, Experience, and Preceptor Attestation (for Uses Defined Under 35.300)(10 CFR 35.57, 35.390, 35.392, 35.394, and 35.396). (01-2020) ML12164A7422020-01-31031 January 2020 NRC Form 313A (Rso), Radiation Safety Officer or Associate Radiation Safety Officer Training, Experience, and Preceptor Attestation (10 CFR 35.57, 35.50). (01-2020) ML13083A1032019-10-31031 October 2019 NRC Form 361N - Non-Power Reactor (NPR) Event Notification Worksheet ML13083A0722019-09-30030 September 2019 NRC Form 313 - Application for Materials License ML13083A0192019-07-31031 July 2019 NRC Form 7 - Application for NRC Export or Import License, Amendment, Renewal, or Consent Request(S) ML13083A1232019-07-31031 July 2019 NRC Form 396 - Certification of Medical Examination by Facility Licensee ML13083A1272019-07-31031 July 2019 NRC Form 398 - Personal Qualification Statement -- Licensee ML13083A1742019-07-31031 July 2019 NRC Form 526 - Certification of Small Entity Status for the Purposes of Annual Fees Imposed Under 10 CFR Part 171 (Effective July 16, 2019) ML13083A1762019-05-31031 May 2019 NRC Form 531 - Request for Taxpayer Identification Number ML13083A2502019-04-30030 April 2019 NRC Form 664 - General Licensee Registration ML19231A2062019-01-31031 January 2019 NRC Form 527 - Request for Information Related to Contractor Charges -- in Accordance with 10 CFR 170.51 ML16025A0332018-12-31031 December 2018 NRC Form 405F - List All Owners, Officers, Directors, and Executive Personnel (Oodep'S) ML13083A1372018-10-31031 October 2018 NRC Form 426 - Authorization to Publish a Manuscript in the NUREG Series ML13083A0942018-06-30030 June 2018 NRC Form 354 - Data Report on Spouse ML13083A1422018-05-31031 May 2018 NRC Form 445 - Request for Approval of Official Foreign Travel ML13083A1522018-04-30030 April 2018 NRC Form 483 - Registration Certificate -- in Vitro Testing with Byproduct Material Under General License ML13083A1072018-04-30030 April 2018 NRC Form 366A - Licensee Event Report (LER) Continuation Sheet ML13083A1062018-04-30030 April 2018 NRC Form 366 - Licensee Event Report (LER) ML13083A2952018-04-30030 April 2018 NRC Form 740M - Concise Note ML13083A2972018-04-30030 April 2018 NRC Form 742 - Material Balance Report ML13083A2982018-04-30030 April 2018 NRC Form 742C - Physical Inventory Listing ML13083A2962018-04-30030 April 2018 NRC Form 741 - Nuclear Material Transaction Report ML13083A2442018-02-28028 February 2018 NRC Form 653 - Transfers of Industrial Devices Report (to General Licensees) ML13083A1082018-02-28028 February 2018 NRC Form 366B - Licensee Event Report (LER) ML13114A5072017-12-31031 December 2017 NRC Form 782 - Complaint Form ML13083A3292017-12-31031 December 2017 NRC Form 781 - Sbcr Compliance Review Part a ML13083A1792017-11-30030 November 2017 NRC Form 536 - Operator Licensing Examination Data ML13083A0172017-10-31031 October 2017 NRC Form 5 - Occupational Dose Record for Monitoring Period ML13083A0052017-10-31031 October 2017 NRC Form 4 - Cumulative Occupational Dose History ML13083A0182017-10-31031 October 2017 NRC Form 64 - Travel Voucher ML13083A0592017-10-31031 October 2017 NRC Form 241 - Report of Proposed Activities in Non-Agreement States, Areas of Exclusive Federal Jurisdiction, or Offshore Waters ML14211A1652017-09-30030 September 2017 NRC Form 749 - Manual License Verification Report ML13083A0022017-08-31031 August 2017 NRC Form 3 - Notice to Employees ML13083A2372017-07-31031 July 2017 NRC Form 629 - Authorization for Payment by Credit Card ML13083A0502017-05-31031 May 2017 NRC Form 212 - Qualifications Investigation Professional, Technical, and Administrative Positions ML13083A0852017-03-31031 March 2017 NRC Form 327 - Special Nuclear Material (SNM) and Source Material (SM) Physical Inventory Summary Report ML19231A1992017-03-31031 March 2017 NRC Form 787 - Freedom of Information Act - User Survey ML13083A0792017-02-28028 February 2017 NRC Form 314 - Certificate of Disposition of Materials ML13083A1802017-01-31031 January 2017 NRC Form 540 - NRC Uniform Low-Level Radioactive Waste Manifest Shipping Paper ML13083A1812017-01-31031 January 2017 NRC Form 540A - Uniform Low-Level Radioactive Waste Manifest Shipping Paper (Continuation) ML13083A1822017-01-31031 January 2017 NRC Form 541 - Uniform Low-Level Radioactive Waste Manifest Container and Waste Description ML13083A0282017-01-31031 January 2017 NRC Form 136 - Security Termination Statement ML13083A1832017-01-31031 January 2017 NRC Form 541A - Uniform Low-Level Radioactive Waste Manifest Container and Waster Description (Continuation) 2022-07-11
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NRC FORM 426 U.S. NUCLEAR REGULATORY COMMISSION 1. NUREG No. New NUREG (10-2018)
NRCMD 3.7 AUTHORIZATION TO PUBLISH A MANUSCRIPT Revised NUREG IN THE NUREG SERIES Supplement NUREG
- 2. Title and Subtitle (See instructions on page 2.)
- 3. Distribution Code(s) (See instructions on page 2.)
Requestor Office Telephone Mail Stop E-mail Call for pickup Return by mail Sensitivity Classifications Technical Editing Required For All NUREGS NUREG-Series Public Technical Editing Date Internal Only (May not contain sensitive unclassified or QTE Contractor Report: Performed By:
classified information.)
Certification & Signatures (See instructions on page 2.)
4.1 Does this manuscript contain copyrighted material? If copyrighted material is involved, sign below to indicate that you have received Yes No permission from the copyright owner to use that material.
Signature and Date 4.2 Does this manuscript require a patent clearance? If yes, NRC Patent Counsel is required. Yes No Signature and Date Office Office Telephone 4.3 Does this manuscript contain new, amended, or existing information collections (such as surveys, forms, reporting, or record keeping)? If yes, the OCIO must review this manuscript. (required)
Yes No Signature and Date Office Office Telephone 4.4 Will you publish a Federal Register notice of this publication's availability? Yes No 4.5 NRC Project Officer (required)
Signature and Date Office Office Telephone 4.6 Contractor, Grantee, or other organization (required, if applicable)
Signature and Date Office Office Telephone 4.7 NRC Public Affairs Reviewer (required, if applicable)
Signature and Date Office Office Telephone 4.8 Author's Signature (required)
Signature and Date 4.9 Signature of Office Deputy Director or Front Office Designee (required) Priorities Signature and Date High Medium Low Reproduction Specfications Number of Size of Reproduced Copy(ies) End Use Graphic Services Needed (if applicable)
- Pages # Copies 8.5 X 11" Black & White Cover Page Layout CD Artwork Hardcopies 8.5 X 5.5" Color Other (specify)
CD Other (specify below) # Distribution Copies # Copies for Author Date Required Time Required (not ASAP)
DVD : AM PM NRC FORM 426 (10-2018) Page 1 of 2
NRC FORM 426 U.S. NUCLEAR REGULATORY COMMISSION (10-2018)
NRCMD 3.7 Instructions for Completing NRC Form 426 "Authorization to Publish a Manuscript in the NUREG Series" Block 2: Title and Subtitle State the complete title and subtitles as you want them to appear on the cover and title page, following the U. S. Government Publishing Office Style Manual 2008 Capitalization Rules. Make them concise, and do not include such words as "report" or "publication" in the title.
Block 3: Distribution NRC Automated Mailing Lists. Distribution codes for Block 3 can be found in NUREG/BR-0188 Rev. 3, "Distribution List Descriptions for NRC Reports and Documents," and can be found at the following link:
http://www.internal.nrc.gov/NRC/NUREGS/index.html NOTE: Per Yellow Announcement 12-065, codes 9A through 9L have been discontinued for NUREG distribution.
http://www.internal.nrc.gov/announcements/yellow/2012/2012-065.html Prepared Mailing Labels. (1) Type pre-addressed peel-off mailing labels for any addressees not included in a mailing list. (2) Type pre-addressed peel-off mailing labels for any NRC addressees, using only the name and NRC mail stop. Include a label for the Project Officer. (3) If any recipient is to receive more than one copy, specify the number of copies in parentheses after the name on the label
[e.g., John Jones (10)].
Block 4: Certifications & Signatures 4.1 If "Yes", and the manuscript contains copyrighted material, attach a letter or an e-mail message of permission from each copyright owner to print the material in a Government publication, to post to NRC's Web site, or both, as appropriate.
4.2 If "Yes", have NRC's Patent Counsel sign Block 4.2 before publishing.
4.3 If "Yes", and the manuscript contains new, amended, or existing information collections (such as surveys, forms, reporting, or record keeping), have an NRC Information Services Branch Reviewer review the manuscript and sign Block 4.3.
4.4 If "Yes," submit a copy of the draft Federal Register notice of availability with the manuscript.
4.5 (Required) Project Officer signs, certifying that the manuscript contains no legally binding regulatory requirements and no sensitive unclassified or classified information.
4.6 (Required, if applicable) Approving Official for contractor, grantee, or other organization signs.
4.7 If manuscript is directed toward public outreach, Office of Public Affairs reviewer signs verifying their review.
4.8 Author's signature (required) 4.9 Signature of Office Deputy Director or Front Office Designee (required)
Priorities: (Check one box)
High Priority - External driven due dates from OMB, Congress, etc. (i.e. CBJ, Strategic Plan), Commission driven due dates (i.e.
Chairman, Commission, SECY, EDO, OCFO), and Licensing actions (i.e. License Renewal, Topical Reports, and items that prevent the issuance of license renewals and Topical Reports).
Medium Priority - Jointly developed with outside stakeholders.
Low Priority - Does not meet medium or high priorities identified above.
NRC FORM 426 (10-2018) Page 2 of 2