ML18269A142
| ML18269A142 | |
| Person / Time | |
|---|---|
| Issue date: | 12/28/2018 |
| From: | NRC/OIP |
| To: | |
| Baker S - 287 9059 | |
| References | |
| Download: ML18269A142 (1) | |
Text
NRC FORM 831 U.S. NUCLEAR REGULATORY COMMISSION APPROVED BY OMB: NO. 3150-0036 EXPIRES: (MM/DD/YYYY)
(MM-YYYY)
Estimated burden per response to comply with this mandatory collection request: 30 minutes. This form 10 CFR 110.50(c)(3)(i) 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, (O-1 F21), U.S. Nuclear Regulatory Commission, Washington, DC 20555-001, or by REPORT OF EXPORT 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.
ADVANCED NOTIFICATION OF SEND COMPLETED FORM TO:
SHIPMENT OF CATEGORY 1 AND/OR 2 RADIOACTIVE SOURCES U.S. Nuclear Regulatory Commission In accordance with 10 CFR Part 110.50(c)(3)(i) ATTN: Headquarters Operation Center of the U.S. NRC Regulations Email: hoo.hoc@nrc.gov (Preferred Reporting Method)
Reference Number: Fax: (301) 816-5151 (Alternative Reporting Method)
Part 110 license number:
A Expiration date:
Name of the individual and licensee making the notification: (address, city, state, zip code and telephone number)
B U. S. exporting facility:
(company name, address, city, state, zip code and telephone number)
Foreign recipient name, address and end use C
location(s) if different than recipient's address:
Radionuclide(s) and activity level in TBq, both D for single and aggregate shipments:
Total Activity Level (TBq):
Make, model and serial number, for any E
category 1 and 2 sealed sources, if available:
F End-use in the importing country, if known:
G Shipment date: (MM/DD/YYYY)
This notification should be accompanied by a copy of the foreign recipient's authorization or confirmation H
of that authorization from the government of the importing country, as required by 110.32(g).
Comments:
NRC Form 831 (MM-YYYY)