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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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PAGE 1 OF 3 NRC FORM 558A U.S. NUCLEAR REGULATORY COMMISSION (10-2000)
NRCMD 11.8
SUMMARY
OF PROPOSAL EVALUATION INTERAGENCY AGREEMENT INSTRUCTIONS Address each question. Address all deviations or unacceptable aspects of the proposal (including any pertinent information provided by the contractor) whether or not they are subsequently found to be acceptable. For all deviations (or initially unacceptable aspects of the proposal), state the deviation, determine acceptability, and, if not acceptable, explain any required changes.
If the cost, technical, and/or any other aspects of the proposal are consistent with the independent government cost estimate (IGCE) and the requirements of the statement of work (SOW), provide an affirmative statement to that effect. If a question is not applicable to the proposal, state that it is not applicable.
COST CONSIDERATIONS Compare the cost proposal with the IGCE. The performing organization is responsible for attesting to the accuracy of the labor rates and indirect rates, i.e., overhead, fringe, and G&A (general and administrative expense), with submission of the proposal. If an IGCE was not required (estimated annual project cost is less than $250,000 or the multi-year project cost is less than $500,000), compare the proposed cost to the statement of work to determine the reasonableness of the proposed costs.
- 1. Are the proposed hours consistent with those identified in the IGCE for each labor category? Provide an analysis of the proposed hours. State the deviations and explain their acceptability. If they are not acceptable, explain required changes.
- 2. Is the proposed travel consistent with that stated in the SOW and necessary for performance of the work? Review the purpose, number of trips, location (origin and destination), number of travel days, and number of personnel traveling. State the deviations from the SOW and explain their acceptability. If they are not acceptable, explain required changes.
- 3. Are the purpose, labor categories and expertise, and number of hours for any proposed subcontractor or consultant reasonable and necessary for performance of the work? Provide an analysis of the proposed labor categories and expertise and the number of hours, and explain their reasonableness and acceptability. If they are not acceptable, explain required changes.
NRC FORM 558A (10-2000) FOR OPTIONAL USE
PAGE 2 OF 3
SUMMARY
OF PROPOSAL EVALUATION (Continued)
COST CONSIDERATIONS (Continued)
- 4. Are the proposed quality and estimated "other direct costs" (such as telephone, express mail, computer time, materials) reasonable and necessary for performance of the work? Are the costs consistent with the independent cost estimate? Provide an analysis of the proposed "other direct costs" and their purpose. State the deviations from the independent cost estimate and explain their reasonableness and acceptability. If not acceptable, explain required changes.
- 5. Has the contractor proposed any Information Technology (IT) resources, testing, or other special equipment? Are they reasonable and necessary for performance of the work? Are they consistent with the independent cost estimate? Provide an analysis of the quantity and prices. State deviations and explain their acceptability. If not acceptable, explain required changes.
TECHNICAL CONSIDERATIONS
- 6. Are the proposed labor categories consistent with those in the SOW (e.g., sufficient level of expertise, all technical areas covered in number and types, availability of personnel when needed)? Provide an analysis of the proposed labor categories. State the deviations and explain their acceptability. If not acceptable, explain required changes.
- 7. If the proposed technical approach is different from that in the SOW, is it reasonable and suitable to accomplish the objective(s)? Are any areas of the approach inappropriate? Provide an analysis of the technical proposal. State the deviations and explain their acceptability. If not acceptable, explain required changes.
PAGE 3 OF 3
SUMMARY
OF PROPOSAL EVALUATION (Continued)
TECHNICAL CONSIDERATIONS (Continued)
- 8. Are the proposed scheduled milestones and the period of performance consistent with the requirements of the SOW? Are they reasonable?
State the deviations and discuss their acceptability. If not acceptable, explain required changes.
- 9. Is the technical proposal fully responsive to the SOW in other areas not evaluated above (e.g., clarity; description and breakdown of the tasks and subtasks to allow appropriate level of monitoring; the description of the type, quality, distribution of reports and another deliverable)? Provide an analysis of the technical proposal. State the deviation and discuss their acceptability. If not acceptable, explain required changes.
OTHER CONSIDERATIONS
- 10. On the basis of the information in the proposal and any other information readily available, does an appearance of or an actual organization conflict of interest exist for the prime contractor or subcontractor or consultant, if applicable, as defined in 48 CFR Part 20? Explain your determination.
- 11. On the basis of the information in the proposal and any other information readily available, are any proposed contractor employees, subcontractor employees, or consultants former NRC employees? If yes, provide the name(s) of the individual(s) and, if known, the termination date of employment with the NRC.
SIGNATURE TYPED OR PRINTED NAME SIGNATURE OFFICE DATE