ML19325D101

Request for OMB Review & Supporting Statement Re NRC Form 472, Diagnostic Misadministration Rept. Estimated Respondent Burden Is 150 H

ML19325D101
Person / Time
Issue date:	10/05/1989
From:	Amenta J NRC OFFICE OF INFORMATION RESOURCES MANAGEMENT (IRM)
To:
Shared Package
ML19325D102	List: ML19325D101 ML19325D103
References
NUDOCS 8910190008
Download: ML19325D101 (2)

Text

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~P u G 3staadgdrmm ah iRequest for 0MB ReviesFS$ M was o

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., : Read instructions before completing form. Do not use the same SF 83 Send three cooies of this form, the material to be reviewed, and for-K to request bo'h an Executive Ordes 12291 review and approval Under -

f.aperwork-thre,s copies of the supporting statemens, to:

4

the Paperwork Reduction Act

'y-Answcr all questions in Part 1. If this request is for review under E.0,N12291; complete Part il and sign the regulat Office of Management and Budget Office of Information and Regulatory Affairs

+

request is for approval under the Paperwork Reduction Act and 5 CFn Attantion: Docket Library, Room 3201

> 1320, skip Part it. complete Part til and s'gn the paperwork certificLtion.

Washington, DC 20503 -

PART l.-Complete This Part for All Requests.'

(. 1. C;partment; agency and Duttau/otuce oggtet.rtg teouest

2. Agency code U.lS. Nuclear Regulatory Commission 3 1 50 -

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c 3. fiarne of perscn ano can best ar.swer Questions regarding this request

. Telephone number James H. Hyers 0 301 )492-0637

4. Title of entormaaon collection or rulemaiung t

.NRC, Form 473 Diagnostic Misadministration Report

5. Legan uthct,ty f or information coIIection or ru e (cite united States Code. Puohc lse. or becutove Order) s "42i usC 2.2.01(o)

.or

6. Affected pubfsc (check allthatapply)

.$ @ Federalagencies or employees

' 1 - O ind viduals or households 3 0 ra,ms e G Non profitinstitutions 2 3 State cdoca! governments -

4 Os eusinesses or other for profit 7 G smaiiwsinesses or orgamrations

, PART ll.-Complete This Part On'y if the Request is for OMB Review Under Executive Order 12291 -

i 1

7. R *gutation ident6er Number (RIN) 1

_ ~~~ _.:

_ _ _ or. None assigned O

' Wpe of submess<on (Check one on ea.-h category)

Type of review requested

,~ '

Classification Stage of development

! O Standard i O Ma.or i O 'proposedordr6;t 2 O pending 2 0. Non,,ior -

2 O rina;o,,ntnmt,nar.witnpriorproposar 3 O Emergency '

e 3 0 rinar o,intenm rinai. witr aut enor proposai 4 O Statutomorjudiciaideadhne

- 9. CF R section affected -

L CFR'

~ 10. Does this regmation contain reporting or recordkeeping requirements that reauere OMB approvai under the Paperwork Reduction A.

i U and 5 CFR 1320?

O ves-O no

11. If a maior rule. :s there a regulatory impact analysis attached?

1 O yes 2 O..a If"N ? die OMB waive the ane ysis?

3 0 Yes 4 O No s

_ C:rtification for Regulatory Submissions

.. in submitting tnts request for OMB review. tne authorized regulatory contact and the program official certify that the requirements ni E.0 12291 and any apphcable pohey directives have been comphed with,

. Signature et : egram official Date a

hgnature of authorized regulatory contatt Date 12, t0hf 0 Use only?

Itevous ed.t.ons oomete

• • 1. 1. 'd ",1,'" 8,f ed 83 108 mn naooo emio3a b

0 P goA s cFR 1329. id E O 12291 891C190008 891003 j\\

PDR ORG EUSOMB PDC

c ; PART IH.-Complete This Part Cnly if the Request is for Appr;valcf e C*llecti:n

- of Inf"rmati:n Und:t the Paperw rk R;ducti?n Act and 5 CFR 1320.

OI Ab be needs.us e Oftad acMDesc"Sa f e ty, hs ald affected put'lic in 50 words or lessac ioactiw Materials, Nuclear Medicine"

. tion I~:NRC' Form 473 is userf by NRC medica 1Llicensees to report diagnostic misadministrations-of

[: r:diohtarmaceuticala as required by 10 CFR Part 35.

The information is used by NRC to determine

.what1 kinds of. actions precipitate misadministrations and also as a measure of the-licensee's p'}Jmanag:mentcontroloftheradiationsafeturogram.

}4_, Type c,f information collection (check only one) j

. Information collections not containedin rules

' 13 Regutar submission 2 O Emergency subi.nssion(certifecation attached)

I; fortnation coIIe:tions containedin rules

'3 O Eusting regulation (no changeproposed) 6 Fir al or intenm fina' withcut pnor NPRM

7. Enter date of expected or actual Federal 4 O Notice of proposed rulemaking(NoFM)

A O Reguta'submtssion Register publication at this stage of rulemaking 5 0 rinal, NPRM was previously published B C Emergency suom'ssion(csrt1,catoattached)

(month day, year):

l: a 15. Type of review requested (check only one) 1 C New co:lection "

4 O Reinstatement of a previousiy approved cohection for which approvai h* * '**d 2 O Reesiun of a currently approved co!lection 3 3 Extension of the empiration date of a currently approved ( liect.on 5 O E= sting cotiection in use witnout an OvB controi number without ar.y change en the substance or in the method of,04(4 tion

16. Agency report form number (s)(onclude standard /optionalform number (s))

22 Purp 'se of inforrration collect.on (check as enany as apply)

NRC Form 473 1 O w "

• forbenefe F..

2 O Program evaluatca 17, Annual reportir.g or d sclosure burden 3 0 centramurpose statistics

'l Number of respondents.

4 @ Regulatoryorcomphance 1

2 Number of responses per respondent

- 5 0 Program planning ar ma,agement 300 6 O Research 3 Total annual respor,ses (hne j times hne 2).

.5 7 O Audit 4 Hours per response

$Y 5 Totbl hours [hne 3 times hne 4) 3

' 18. Annual recordkeeping burden

23. Frequency of recordkeeping or ieporting(check allthat apply)

- 1 Number of recorduceoers 1 O Recordkeeping

. 2 Annual hours per recordkeeper, Reporting 3 Total recordkeeping hours (hne j times hne 2) 2 3 Onoccasion

< s4 Ric?rdkeepirg retention perod years 3 0 vieeuy 19, Total annual b.rden.

4 O M' nthiv o

l SbO 5 0 Quarterly 1

.1 Requested (kne J M plus hne 18-3).

500 6 O semi-annuaily

- 2 in current OMB inventory

-3 Ditfirence (tine 1 less hne 2)

- 350 7 O Annually Esplanation of difference 8 O Be niaily 4 Program change 9 O Otner(desende):

5 Adjustment.

1

- 350

' 20. Current (most recent) OMB contr01 number or comment number

24. Respondents' obligation to comply (check the strongest obhgation that apphes)

-3150-0140 1 O voluntary 21 Requested empiration dat*

2 O Required to obtain or reta n a benefit 3 @ Mandatory 3 years from-approval date i

i 25. Ara the respondents pnmarily educational agencies or institutions or is the pnmary purpose of the collection related to Federal education programs? O ;

26. Does the agene! use sarnohng to select respondents or does the ager cy recommend or &resenbe the use of samphng or stati

. Oyes 0 No by responcents I

27. Regulatory authority for tne information collec* ion 10 CFR._11.J3 (c )

, or FR

or, Other (specify)

Paperworn Certification in subetting this request fo' OMB approvai, the agency head, the sen or off;cial or an authorized representative, certifies that the requirements of 5 CFR 1320, the 1 Pnvacy Act, statistical star.darcs or directnes, and any other appheabie information rohey directives have been comnhed wsth Date S.gnatur 6 regram officiat AW

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Date Sgnatua f ',encf head the seruor officdler arf authonzed representative

. Aycd Naenta. Designated Senior Of ficial

.fcr Ipformation Resources Management O OPo 1984 o - 453-776

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