ML19165A148
| ML19165A148 | |
| Person / Time | |
|---|---|
| Issue date: | 09/09/2019 |
| From: | Division of Inspection and Regional Support |
| To: | NRC/OCIO |
| Mark King | |
| Shared Package | |
| ML19150A230 | List: |
| References | |
| NRC-2019-0085, OMB 3150-0104 | |
| Download: ML19165A148 (2) | |
Text
APPROVED BY OMB: NO. 3150-0104 EXPIRES: (MM/DD/YYYY)
NRC FORM 366 U.S. NUCLEAR REGULATORY COMMISSION (MM-YYYY) Estimated burden per response to comply with this mandatory collection request: 80 hours9.259259e-4 days <br />0.0222 hours <br />1.322751e-4 weeks <br />3.044e-5 months <br />. Reported LICENSEE EVENT REPORT (LER) lessons learned are incorporated into the licensing process and fed back to industry. Send comments regarding burden estimate to the Information Services Branch (T-6 A10M), U.S. Nuclear Regulatory (See Page 3 for required number of digits/characters for each block) Commission, Washington, DC 20555-0001, or by e-mail to Infocollects.Resource@nrc.gov, and to the Desk Officer, Office of Information and Regulatory Affairs, NEOB-10202, (3150-0104), Office of (See NUREG-1022, R.3 for instruction and guidance for completing this form 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 http://www.nrc.gov/reading-rm/doc-collections/nuregs/staff/sr1022/r3/) person is not required to respond to, the information collection.
- 1. Facility Name 2. Docket Number 3. Page 05000 1 OF
- 4. Title
- 5. Event Date 6. LER Number 7. Report Date 8. Other Facilities Involved Sequential Revision Facility Name Docket Number Month Day Year Year Month Day Year Number No.
05000
- - Facility Name Docket Number 05000
- 9. Operating Mode 10. Power Level
- 11. This Report is Submitted Pursuant to the Requirements of 10 CFR §: (Check all that apply) 10 CFR Part 20 20.2203(a)(2)(vi) 50.36(c)(2) 50.73(a)(2)(iv)(A) 50.73(a)(2)(x) 20.2201(b) 20.2203(a)(3)(i) 50.46(a)(3)(ii) 50.73(a)(2)(v)(A) 10 CFR Part 73 20.2201(d) 20.2203(a)(3)(ii) 50.69(g) 50.73(a)(2)(v)(B) 73.71(a)(4) 20.2203(a)(1) 20.2203(a)(4) 50.73(a)(2)(i)(A) 50.73(a)(2)(v)(C) 73.71(a)(5) 20.2203(a)(2)(i) 10 CFR Part 21 50.73(a)(2)(i)(B) 50.73(a)(2)(v)(D) 73.77(a)(1)(i) 20.2203(a)(2)(ii) 21.2(c) 50.73(a)(2)(i)(C) 50.73(a)(2)(vii) 73.77(a)(2)(i) 20.2203(a)(2)(iii) 10 CFR Part 50 50.73(a)(2)(ii)(A) 50.73(a)(2)(viii)(A) 73.77(a)(2)(ii) 20.2203(a)(2)(iv) 50.36(c)(1)(i)(A) 50.73(a)(2)(ii)(B) 50.73(a)(2)(viii)(B) 20.2203(a)(2)(v) 50.36(c)(1)(ii)(A) 50.73(a)(2)(iii) 50.73(a)(2)(ix)(A)
OTHER (Specify here, in abstract, or NRC 366A).
- 12. Licensee Contact for this LER Licensee Contact Phone Number (Include area code)
- 13. Complete One Line for each Component Failure Described in this Report Cause System Component Manufacturer Reportable to IRIS Cause System Component Manufacturer Reportable to IRIS
- 14. Supplemental Report Expected Month Day Year
- 15. Expected Submission Date No Yes (If yes, complete 15. Expected Submission Date)
- 16. Abstract (Limit to 1400 spaces, i.e., approximately 15 single-spaced typewritten lines)
REQUIRED NUMBER OF DIGITS/CHARACTERS FOR EACH BLOCK BLOCK NUMBER OF TITLE NUMBER DIGITS/CHARACTERS 1 UP TO 110 / 2 LINES FACILITY NAME 10 TOTAL 2 DOCKET NUMBER 5 IN ADDITION TO 05000 3 VARIES PAGE NUMBER 4 UP TO 195 / 2 LINES TITLE 8 TOTAL 2 FOR MONTH 5 EVENT DATE 2 FOR DAY 4 FOR YEAR 9 TOTAL 4 FOR YEAR 6 LER NUMBER 3 FOR SEQUENTIAL NUMBER 2 FOR REVISIONS NUMBER 8 TOTAL 2 FOR MONTH 7 REPORT DATE 2 FOR DAY 4 FOR YEAR UP TO 25 -- FACILITY NAME 8 10 TOTAL -- DOCKET NUMBER OTHER FACILITIES INVOLVED 5 IN ADDITION TO 05000 9 1 OPERATING MODE 10 3 POWER LEVEL VARIES 11 CHECK ALL BOXES THAT APPLY REQUIREMENTS OF 10 CFR UP TO 75 FOR NAME 12 LICENSEE CONTACT 10 FOR TELEPHONE CAUSE VARIES (UP TO 8) 2 FOR SYSTEM (UP TO 8) 13 4 FOR COMPONENT (UP TO 8) EACH COMPONENT FAILURE 4 FOR MANUFACTURER (UP TO 8)
IRIS VARIES (UP TO 10) 1 14 SUPPLEMENTAL REPORT EXPECTED CHECK BOX THAT APPLIES 8 TOTAL 2 FOR MONTH 15 EXPECTED SUBMISSION DATE 2 FOR DAY 4 FOR YEAR 16 1400 SPACES OR 15 LINES OF TYPING ABSTRACT NRC FORM 366 (MM-YYYY)