ML18269A143

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NRC Form 831A - Report of Export Continuation Sheet
ML18269A143
Person / Time
Issue date: 12/28/2018
From:
NRC/OCIO, NRC/OIP
To:
Baker S - 287 9059
References
Download: ML18269A143 (1)


Text

NRC FORM 831A U.S. NUCLEAR REGULATORY COMMISSION APPROVED BY OMB: NO. 3150-0036 EXPIRES: (MM/DD/YYYY)

(MM-YYYY) 10 CFR 110.50(c)(3)(i)

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, (O-1 F21), U.S. Nuclear Regulatory Commission, Washington, DC 20555-001, or by e-mail to REPORT OF EXPORT 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 CONTINUATION SHEET 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)(ii) ATTN: Headquarters Operation Center of the U.S. NRC Regulations Email: hoo.hoc@nrc.gov (Preferred Reporting Method)

Fax: (301) 816-5151 (Alternative Reporting Method)

Reference Number:

Part 110 License Number:

Expiration Date of Part 110 License Number:

SOURCE ACTIVITY (TBq) MAKE MODEL SERIAL NUMBER 1

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