ML18179A369
| ML18179A369 | |
| Person / Time | |
|---|---|
| Issue date: | 08/30/2018 |
| From: | NRC/OIP |
| To: | |
| Baker S - 287 9059 | |
| References | |
| Download: ML18179A369 (5) | |
Text
Page 1 of NRC FORM 7 U. S. NUCLEAR REGULATORY COMMISSION APPROVED BY OMB: NO. 3150-0027 EXPIRES: 11/30/2018 (02-2016) Estimated burden per response to comply with this mandatory collection request: 2.4 hours4.62963e-5 days <br />0.00111 hours <br />6.613757e-6 weeks <br />1.522e-6 months <br />. This 10 CFR 110 submittal is reviewed to ensure that the applicable statutory, regulatory, and policy considerations are satisfied. Send comments regarding burden estimate to the FOIA, Privacy, APPLICATION FOR NRC EXPORT OR IMPORT and Information Collections Branch (T-5 F53), U.S. Nuclear Regulatory Commission, Washington, DC 20555-0001,or by e-mail to Infocollects.Resource@nrc.gov, and to the Desk LICENSE, AMENDMENT, RENEWAL, Officer, Office of Information and Regulatory Affairs, NEOB-10202, (3150-0027), Office of Management and Budget, Washington, DC 20503. If a means used to impose an information OR CONSENT REQUEST(S) collection does not display a currently valid OMB control number, the NRC may not conduct or (See Instructions on Pages 4 and 5) sponsor, and a person is not required to respond to, the information collection.
DATE RECEIVED PART A. FOR NRC USE ONLY PUBLIC OR NON-PUBLIC LICENSE NUMBER DOCKET NUMBER ADAMS ACCESSION NUMBER PART B. TO BE COMPLETED FOR ALL LICENSES, AMENDMENTS, RENEWALS, OR CONSENT REQUESTS (If more space is needed to complete any of the items, use Pages 3-4 first, and then attach additional sheets, if necessary.)
- 1. NAME AND ADDRESS OF APPLICANT/LICENSEE 1a. NAME OF APPLICANT'S CONTACT 1b. APPLICANT'S REFERENCE NUMBER 1c. PHONE NUMBER 1d. FAX NUMBER 1e. E-MAIL ADDRESS
- 2. TYPE OF ACTION REQUESTED (Check One) CONSENT REQUEST EXPORT IMPORT AMENDMENT/RENEWAL (Parts B, C)
(Parts B, C, E) (Parts B, D, E) Current License Number: Current License Number:
- 3. CONTRACT NUMBER(S) 4. FIRST SHIPMENT DATE 5. LAST SHIPMENT DATE 6. PROPOSED EXPIRATION DATE PART C. TO BE COMPLETED FOR EXPORT LICENSES, AMENDMENTS, OR RENEWALS (If more space is needed to complete any of the items, use Pages 3-4 first, and then attach additional sheets, if necessary.)
- 7. NAME(S) / ADDRESS(ES) OF SUPPLIERS 8. NAME(S) / ADDRESS(ES) OF INTERMEDIATE 9. NAME(S) / ADDRESS(ES) OF ULTIMATE AND/OR OTHER PARTIES TO THE EXPORT FOREIGN CONSIGNEE(S) FOREIGN CONSIGNEE(S) 7a. FUNCTION(S) PERFORMED/SERVICE(S) PROVIDED 8a. INTERMEDIATE USE(S) 9a. ULTIMATE END USE(S)
- 10. DESCRIPTION OF RADIOACTIVE MATERIALS, SEALED SOURCES, 10a. MAX TOTAL VOLUME / 10c. MAX ISOTOPE NUCLEAR FACILITIES, EQUIPMENT, OR COMPONENTS; FOR 10b. MAX ENRICHMENT ELEMENT WGT (KG), OR WGT (KG)
NUCLEAR EQUIPMENT INCLUDE TOTAL DOLLAR VALUE OF OR WGT %
TOTAL ACTIVITY (TBq)
EQUIPMENT FOR EXPORT
- 11. FOREIGN OBLIGATIONS (BY COUNTRY AND BY PERCENTAGE OF MAXIMUM TOTAL VOLUME)
NRC FORM 7 (02-2016)
Page 2 of NRC FORM 7 U. S. NUCLEAR REGULATORY COMMISSION (02-2016) 10 CFR 110 APPLICATION FOR NRC EXPORT OR IMPORT LICENSE, AMENDMENT, RENEWAL, OR CONSENT REQUEST(S) (Continued)
LICENSE NUMBER DOCKET NUMBER ADAMS ACCESSION NUMBER PUBLIC OR NON-PUBLIC PART D. TO BE COMPLETED FOR IMPORT LICENSES, AMENDMENTS, OR RENEWALS (If more space is needed to complete any of the items, use Pages 3-4 first, and then attach additional sheets, if necessary.)
- 12. NAME(S) / ADDRESS(ES) OF FOREIGN
SUPPLIERS AND/OR OTHER PARTIES CONSIGNEE(S) CONSIGNEE(S)
TO IMPORT 12a. NRC EXPORT LICENSE NUMBER(S) 13a. LICENSE NUMBER(S) / EXPIRATION DATE(S) 14a. LICENSE NUMBER(S) / EXPIRATION DATE(S)
(if applicable) 13b. INTERMEDIATE USE(S) 14b. ULTIMATE END USE(S) 15a. MAX TOTAL VOLUME /
- 15. DESCRIPTION OF RADIOACTIVE MATERIALS, SEALED SOURCES, 15b. MAX ENRICHMENT 15c. MAX ISOTOPE ELEMENT WGT (KG), OR NUCLEAR FACILITIES OR WGT % WGT (KG)
TOTAL ACTIVITY (TBq)
- 16. FOREIGN OBLIGATIONS (BY COUNTRY AND BY PERCENTAGE OF MAXIMUM TOTAL VOLUME)
PART E. TO BE COMPLETED FOR ALL LICENSES, AMENDMENTS, RENEWALS OR CONSENT REQUEST(S)
- 17. ADDITIONAL INFORMATION YES NO 17a. COPIES OF RECIPIENTS' YES NO PROVIDED ON PAGES 3, 4, AUTHORIZATIONS PROVIDED?
AND/OR ON SEPARATE SHEETS?
I, the applicant's authorized official, hereby certify that this application is prepared in conformity
- 18. CERTIFICATION: with Title10, Code of Federal Regulations, and that all information provided is correct to the best of my knowledge.
18a. PRINT NAME AND TITLE OF AUTHORIZED OFFICIAL 18b. SIGNATURE -- AUTHORIZED OFFICIAL 18c. DATE NRC FORM 7 (02-2016)
Page of NRC FORM 7 U. S. NUCLEAR REGULATORY COMMISSION (02-2016) 10 CFR 110 APPLICATION FOR NRC EXPORT OR IMPORT LICENSE, AMENDMENT, RENEWAL, OR CONSENT REQUEST(S) (Continued)
LICENSE NUMBER DOCKET NUMBER ADAMS ACCESSION NUMBER PUBLIC OR NON-PUBLIC ADDITIONAL INFORMATION (Reference applicable block numbers from page 1 and/or page 2 for each entry)
NRC FORM 7 (02-2016)
U. S. NUCLEAR REGULATORY COMMISSION INSTRUCTIONS FOR PREPARATION OF NRC FORM 7, APPLICATION FOR NRC EXPORT OR IMPORT LICENSE, AMENDMENT, RENEWAL OR CONSENT REQUEST(S)
General Instructions: A completed, signed original NRC Form 7 may be mailed to the Deputy Director, Office of International Programs, U.S. Nuclear Regulatory Commission, Washington, DC 20555-0001, or hand-delivered to the Deputy Director at 11555 Rockville Pike, Rockville, Maryland 20852.
Refer to Title 10 of the Code of Federal Regulations, Part 110, for specific NRC export/import licensing requirements. For each license, amendment or renewal application, identify all foreign and domestic locations where exports or imports will be handled, sorted, repackaged and/or processed in any way. Provide information on quantities, forms, and other characteristics of the radioactive materials, sealed sources, nuclear facilities and equipment to be exported or imported and indicate how they will be used by each of the parties listed. If more space is needed to complete any of the items on this form, use the continuation pages first, and then attach additional sheets. Reference appropriate BLOCK number(s) for each entry on all additional sheets. All applicants should avoid submitting proprietary information unless absolutely necessary, as NRC is required to make copies of all applications received available to the public. If proprietary information must be submitted, follow procedures in 10 CFR 2.390, otherwise, such information could be publicly disclosed and/or processing of an application could be significantly delayed.
An application for a specific license to export or import or a request for an exemption from a licensing requirement must be accompanied by the appropriate fee in accordance with 10 CFR Part 170. The fee schedules are provided in §§ 170.21 and 170.31. The reference IMEX should be included on your form of payment. A license application will not be processed unless the specified fee is received.
NOTE: FOR CONSENTS FILL OUT BLOCKS, BLOCK 5. Enter the anticipated date of last shipment (1a-e,2,8,9,10,10a,17,18) (MM/DD/YYYY).
PART A. FOR NRC USE ONLY BLOCK 6. Enter a proposed license expiration date (MM/DD/YYYY), to accommodate export activities. Note that PART B. TO BE COMPLETED BY ALL APPLICANTS FOR NRC licenses are typically issued for 1-5 years.
ALL LICENSES, AMENDMENTS, RENEWALS, OR NOTE: For amendments and renewals, provide only the new CONSENT REQUEST(S) or changed information, as appropriate, in PART C and/or BLOCK 1. Enter name and complete physical address of the PART D. (For example, enter names and addresses of parties corporation or other entity with direct control over distribution or consignees, only if they need to be added to, deleted from, of proposed export(s) or import(s), and where required or their information needs to be changed. If seeking to records will be maintained and can be inspected. Post Office increase the volume or quantity of material or equipment, Box Numbers or names of divisions or departments within a specify the additional increment, and, if applicable, indicate legal entity are NOT acceptable entries for this BLOCK. what the new, combined cumulative total will be.)
PART C. TO BE COMPLETED BY APPLICANTS FOR BLOCKS 1a-e. Provide name and contact information EXPORT LICENSES, AMENDMENTS, RENEWALS, identifying the best party to answer questions about an OR CONSENTS application. Applicants should use BLOCK 1b to assign their own reference number to identify application documents. BLOCK 7. Enter names of supplier(s) and other parties to export not listed in BLOCKS 1, 8, OR 9. Provide complete BLOCK 2. Indicate the TYPE OF NRC LICENSING ACTION physical address(es) where correspondence should be sent requested by checking: and where export(s) can be inspected. Post Office Box Numbers are NOT acceptable entries for this BLOCK.
- EXPORT if applying for a new export license.
BLOCK 7a. Describe functions to be performed and/or
- IMPORT if applying for a new import license.
services to be provided by any parties listed in BLOCK 7.
- AMENDMENT OR RENEWAL if applying to modify or extend an export or import license previously issued by NRC BLOCKS 8-9. Enter names and physical address(es) for each (and not yet expired). Include NRC license number in space intermediate and each ultimate foreign location. Post Office provided. If NRC receives an amendment/ renewal application Box Numbers are NOT acceptable entries for these BLOCKS.
at least 30 days or more before the license expires, its terms BLOCKS 8a and 9a. Describe how each consignee will use will remain valid and, if circumstances permit, it can continue export(s), including functions to be performed and/or services to be used until NRC completes action on the amendment or to be provided.
renewal application.
BLOCK 10. Describe key characteristics including physical
-CONSENT REQUEST if submitting a request for the NRC to and chemical forms, etc., of radioactive materials (i.e., source, obtain government-to-government consent to authorize special nuclear or byproduct materials including sealed shipment(s) of Category 1 quantities of byproduct material.
sources or devices and radioactive waste), nuclear facilities Include NRC license number in space provided.
uranium, or thorium, and provide chemical form (e.g., U3O8, BLOCK 3. If known, provide contract number(s), which may Th-227). Identify and provide total volume in kilograms of ores be useful references for example, if reviewers need to contact containing 0.05% or more of source material (e.g., tantalum, recipients or other parties listed on the application. niobium) and specify source material contained. Identify special nuclear material as plutonium, high enriched uranium BLOCK 4. Enter the anticipated date of the first shipment (> 20% U-235) or low enriched uranium (<20% U-235) and (MM/DD/YYYY). specify chemical form.
U. S. NUCLEAR REGULATORY COMMISSION INSTRUCTIONS FOR PREPARATION OF NRC FORM 7, APPLICATION FOR NRC EXPORT OR IMPORT LICENSE, AMENDMENT, RENEWAL OR CONSENT REQUEST(S) CONTINUED Identify Appendix L byproduct materials by name and form, BLOCK 15. Describe key characteristics including physical including maximum total activities and types of sealed and chemical forms, etc., of radioactive materials (i.e., source, sources and/or devices to be exported over the license life. special nuclear or byproduct materials including sealed Identify Appendix P materials by name and form, including sources or devices and radioactive waste), and nuclear maximum total quantities(activity in TBq) and types of sealed facilities. For radioactive waste, identify and provide maximum sources and/or devices to be exported on a per shipment basis. total volume in kilograms for each non-radioactive material For radioactive waste, identify and provide maximum total (e.g., contaminated steel) involved, and physical and chemical volume in kilograms for each non-radioactive material involved, forms for each radioactive source, special nuclear or and physical and chemical forms for each radioactive material, byproduct material. Provide overall waste classification (see along with the overall waste classification (see 10 CFR 61.55) 10 CFR 61.55) if imported for direct disposal at a Part 61 or if exported for the purposes of disposal in a land disposal equivalent Agreement State licensed facility; responsible facility as defined in 10 CFR Part 61, a disposal area as industrial process, route(s) of transit, and the status of defined in Appendix A to 10 CFR Part 40, or an equivalent arrangements for disposition in the U.S., e.g., any agreement facility; route(s) of transit, forms of management and ultimate by a low-level waste compact or State to accept for disposition. For nuclear facilities, provide total quantity; types; management or disposal. For nuclear facilities, provide total names, design power or annual capacity rating; and the quantities; types; names, design power or annual capacity estimated combined total dollar value. For nuclear equipment, rating; and the estimated combined total dollar value.
identify all items by name, total quantity and function and provide the estimated combined total dollar value. BLOCK 15a. For source and/or special nuclear material, provide maximum total volume/element weight over license BLOCK 10a. For source material, provide maximum total life in kilograms. For Appendix L byproduct material, including volume/element weight over license life in kilograms. For that which is in the form of radioactive waste, provide special nuclear material, provide maximum total element maximum total activity over license life in TBq.
weight over license life in kilograms. For each Appendix L byproduct material listed, provide maximum total activity over BLOCKS 15b-c. For special nuclear material including that license life in Terabequerels (TBq). For each Appendix P which is in the form of radioactive waste, provide maximum material listed, provide maximum total activity per shipment in enrichment/weight % and maximum total isotope weight over Tbq. license life in kilograms.
BLOCKS 10b-c. For special nuclear material including as BLOCK 16. Identify each country and the percentage of the radioactive waste, provide maximum weight % (enrichment) maximum total volume that may be obligated to them (require and total isotope weight over license life in kilograms. U. S. Government action, e.g., prior notification).
BLOCK 11. Identify each country and the percentage of the PART E. TO BE COMPLETED BY ALL APPLICANTS maximum total volume that may be obligated to them (requires U. S. Government action, e.g., prior notification). BLOCK 17. Check YES or NO to verify whether or not additional information is being provided using the space PART D. TO BE COMPLETED BY APPLICANTS FOR provided on the continuation pages and separate sheets.
IMPORT LICENSES, AMENDMENTS OR RENEWALS BLOCK 12. Enter name(s) and address(es) of foreign BLOCK 17a. Check YES or NO to verify whether or not supplier(s) or exporter(s). copies of domestic recipients' authorizations required for Appendix P materials (see Part 110.32 requirements) are BLOCK 12a. For import(s) originally exported under a specific included with the application.
NRC license, enter that license number.
BLOCKS 18a-c. An authorized official of the legal entity BLOCKS 13a and 14a. Enter NRC or Agreement State applying for the License, Amendment or Renewal, must certify Materials License number(s) including expiration date(s)
(MM/DD/YYYY) for each U.S. consignee, authorizing receipt, possession, use or distribution.