ML13083A359
| ML13083A359 | |
| Person / Time | |
|---|---|
| Issue date: | 10/31/2019 |
| From: | NRC/OCIO/GEMSD/IMSB |
| To: | |
| References | |
| Download: ML13083A359 (1) | |
Text
NRC Form 831A (10-2019)
Part 110 License Number:
NRC FORM 831A (10-2019) 10 CFR 110.50(c)(3)(i)
U.S. NUCLEAR REGULATORY COMMISSION APPROVED BY OMB: NO. 3150-0036 EXPIRES: 10/31/2022 SOURCE 1
ACTIVITY (TBq)
MAKE MODEL SERIAL NUMBER 2
3 4
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9 10 11 12 13 14 15 16 17 18 19 20 REPORT OF EXPORT CONTINUATION SHEET ADVANCED NOTIFICATION OF SHIPMENT OF CATEGORY 1 AND/OR 2 RADIOACTIVE SOURCES In accordance with 10 CFR Part 110.50(c)(3)(ii) of the U.S. NRC Regulations OF PAGE NUMBER:
Estimated burden per response to comply with this mandatory collection request: 30 minutes. This form allows the NRC to request additional information from licensees to determine whether a license should be revoked, suspended, or modified. Send comments regarding burden estimate to the Information Services Branch, (T-6 A10M), U.S. Nuclear Regulatory Commission, Washington, DC 20555-001, or by e-mail to Infocollects.Resource@nrc.gov, and to the Desk Officer, Office of Information and Regulatory Affairs, NEOB-10202, 3150-0036, Office of Management and Budget, Washington, DC 20503. If a means used to impose an information collection does not display a currently valid OMB control number, the NRC may not conduct or sponsor, and a person is not required to respond to, the information collection.
SEND COMPLETED FORM TO:
U.S. Nuclear Regulatory Commission ATTN: Headquarters Operation Center Email: hoo.hoc@nrc.gov (Preferred Reporting Method)
Fax: (301) 816-5151 (Alternative Reporting Method)
Reference Number:
Expiration Date of Part 110 License Number: