ML20028H341
| ML20028H341 | |
| Person / Time | |
|---|---|
| Issue date: | 12/11/1990 |
| From: | Norry P NRC OFFICE OF INFORMATION RESOURCES MANAGEMENT (IRM) |
| To: | |
| References | |
| OMB-3150-0024, OMB-3150-24, NUDOCS 9012240061 | |
| Download: ML20028H341 (8) | |
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important kcad enstructions tietore compictmr torn. Do nct use the same $r 83 Send three cooies of tn.s form the mater,al to t+ renewec and tc' to rer;uest t>oth an Executive Orce 12291 review ano approm unaer paperwork-three con'es of the supportmg statement. to the P perwork Reduction Act AnsW',f all cuestions en Part ! If tNs reDuest 15 for review under E O Of fice c'informat on and Reputator, Attairs 1229L comp +te Pe t u en:: sir, the reractor, certif action if this Of fic e ot t/anagement an: Bucret teovest IS for approvM dn0(t the Paperworb. Reggetio 1 A;t and $ CrR Attention Doch t t litearp Room 3201 1320. 500 Pa t it. cc. rap ete Pvt lii end 5 gn t*e paa rwork ce et fication Washminon. DC 20503 PART l.-Complete This Part for All Requests.
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- 4. w,et,w,-anonenute eru,e,,r, NRC Form 396, Certification of Medical Examination By Facility Licensee
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PART tl.-Complett This Part OnNif the Recuest is for OMO Review Under Executive Order 12291
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of inf rtmrtlen,Under the Paperwqth Reducti!n Act end_$_CFR 1320.
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- 0. Atat' art--Descritie npos, ms end attectemtAC m 60 words oness " Medical Examination Nuclear Power P1 ants" NRC Form 396 establishes the procedure for transmittalof information to the NRC regarding the icdical condition of applicants for initial or renewal power plant operator licenses.
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- 15. ce the resoo" cents prinW6 educat;onal egencies or institutions or 4 tne crimary purtese of the conection related to Fece'ai educaten pre.g'ams> C ves 0 No
- 26. Daes the atency use samng to seicct responcents o' coes the agency recommend or prescribe the use of samoung or stat 4trcat analysm by respondent $
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%very Act, stttmt :ai a ancarcs or ofrectyes. and any other appocable irf ormation Pohey directwes tave teen comphed with.
kratu e or p'opa%mciai Date r
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Patricia G. Norry, 0S0 for Information R so'u ag nf
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SOFFORTING ST/,TEFENT FOR NRC FORM 396, " CERTIFICATION OF PEDICAL D:/RINATICh EY FACILITY LICENSEE" 10 CFR PART 55, SECTIONS 55.23, 55.25, 55.27, 55.31 AND 55.57 (OMB CLEARAhCE f0. 3150-C024)
DESCPIPTION OF THE IN50RNATION COLLECTION 10 CFR 55.23 specifies that the facility licensee certify the tredical fitr4ss cf an applicant er licensee by ccmpleting ard signing Form NRC 396.
10 CFR 55.25 recutres the faci'lity licensee to notify the NRC if a licensee develops a condition that causes the licensee to fail to rueet +ae requirements of 55.21.
For conditions where a conditior.a1 license is regrested, the facility licensee raust provide tredical certificatien en Form NRC 396.
10 CFR 55.27 specifies the documentation, naintenance c'.d retention cf the n.coical data.
10 CFR 55.31(a)(6) states in erder to apply for a license the (4.plicant shall provide certificction by the facility licensee of medical condition and general health on Form flRC 39C to comply with 55.21,55.23and55.33(a)(1).
10 CFR 55.57(a)(6) specifies that for a renewal of a license, certification must be provided by the facility licensee of the ineoical condition anc general hulth of the applicant on Form NRC 396.
l A.
JUSTIFICATION 1.
Need for the Collections of Information Currently, the n.edical requinments of 10 CFR 55, " Operator's Licenses," requires an applicant to be examined by a licensed n.coical rrtctitioner who will use guidance provideo by ANSI /ANS 3.4-1983 as endorsed by hRC Regulatcry Guide 1.134 The licensed medical practitioner submits his/her diagnostic report to the facility licensee. The facility licensee, based on the data provided, certifies on NRC form 396 whethor or not the applicant is healthy enough to prevent operational errors endangering rublic health and safety.
In cases where the applicant for en operator's license or renewal does not meet the meoical requirements or after recovery from a disabling condition, the facility licensee shall submit supporting
1
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meoical evidence for review ty the f;RC consultant exariinirg physici6n. The NPC and the consultant physician will review such evidtnce and cecide if a conditional license or reinstatement from 3
the disatility shall be approved.
2.
Acency use of Information The NRC uses the infcrmation as part of the basis for detcrminirp the fitness of an individual for licensing as a Peactor Cperator or Senior Reactor Operator, i
3.
Reduction of Purden Throuch Inforn.ttion Technolooy There is no legal obstacle to the use of information tcchnology.
Moreover, NRC encourages its use.
4 Duplication with Other Collections of Informat%n This infortnation does not duplicate nor overlap other information collections made b The Information Rtquirements Control Autcoated System (y the f:RC.IRCAS) was searched, and no duplication w 5.
Use of similar Information The informotion is available only from facility licensees for toch applicant for an operator license, new and renewal. No similar inf orr.ati(n cxists.
6.
Curden on Small Business This information colle-tion does not involve any small tsusinesses.
7.
Conscouences of Less frequent Collection Information is to be provided only upon request f or 1stuence of a license, renewal of a license (every six yeers) or upon notification to NRC of disttility.
Frequency of repcrting carnot be reouced without endangering the health and saf ety of the public.
O.
Variation frco OMB Guidelines, This request does r.ot vary from OMB guidelines.
9.
Consultations Cutside the NRC There have been no formal consultations outside the NRC regardir.g this form.
10.
Confidentiality of Information l
NRC 16, System of Records, specifies cor.fidentiality of these records.
These records are limited to those persons whose official duttet require such access.
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- 11. Sensitive Questions The facility licensee nust certify that an applicant for an NRC operators license meets safeguards requirements for Ortscorted access to vital areas of a nuclear power plant. This certificetion requires a f acility review of the applicants criminel history, if any.
- 12. Estimated Annualized Cost to the federal Government Estimate of annual cost to the Federal Government is based on staff experience.
It is estimated that 1350 certificates will bc futmitted annually during the clearance period. Also, it is estimated that 100 of there certificates will be required to be revicwid by the NRC Consultant Physician and would require approximately two hours review each. Total federal Covernment cost includes the following:
NRC Consultant Exemining Physician:
100 certificates ennually X 2 hours2.314815e-5 days <br />5.555556e-4 hours <br />3.306878e-6 weeks <br />7.61e-7 months <br /> each = 200 hours0.00231 days <br />0.0556 hours <br />3.306878e-4 weeks <br />7.61e-5 months <br /> 0 $37.38/ hour = $7,476 initial and final staff rt. view:
1350 x.2 hours2.314815e-5 days <br />5.555556e-4 hours <br />3.306878e-6 weeks <br />7.61e-7 months <br /> = 270 Feurs X
$92 = $24,840 Total ennual cost to the scvernment is (31,316 13.
Estimate of Industry Burden and Costs (a) Reportina Pecuirements Approximately 800 new and 500 renewal applicant certifications are expected to be completed by facility licensees annually.
Approximately 50 notifications cf disability are also expected annually. This is an incr(ase of 350 from the current OMD submittal. Although renewal applicant submittals will not commence until May 1993 due to the May 1987 Part 55 rule change which extended the renewal period f rom two to six years, for the purpcsc of this submittal the 1500 expected renewals from May 1993 through January 1994 has been averaged over a three year period. Also included in this submittal are notificttions of disability which were previously covered under 0MB Cirarance 3150-0018. The number of riotifications of diseb nity has been increased for this submittal based on the nunter of notifications received during the current reporting period.
Data for this submittal was retrieved from the Operator Licensing Tracting System. The estimated annual reporting burden per applicant is.25 hours2.893519e-4 days <br />0.00694 hours <br />4.133598e-5 weeks <br />9.5125e-6 months <br />.
800/New Applicants X.25 hours2.893519e-4 days <br />0.00694 hours <br />4.133598e-5 weeks <br />9.5125e-6 months <br /> = 200 hours0.00231 days <br />0.0556 hours <br />3.306878e-4 weeks <br />7.61e-5 months <br /> 500/ Renewal Applicants X.25 hours2.893519e-4 days <br />0.00694 hours <br />4.133598e-5 weeks <br />9.5125e-6 months <br /> = 125 hours0.00145 days <br />0.0347 hours <br />2.066799e-4 weeks <br />4.75625e-5 months <br /> 50/ Notices of Disebility X.25 hours2.893519e-4 days <br />0.00694 hours <br />4.133598e-5 weeks <br />9.5125e-6 months <br /> = 13 hours1.50463e-4 days <br />0.00361 hours <br />2.149471e-5 weeks <br />4.9465e-6 months <br /> Total arrual burden is 1350 x.25 hours2.893519e-4 days <br />0.00694 hours <br />4.133598e-5 weeks <br />9.5125e-6 months <br /> a 338 hours0.00391 days <br />0.0939 hours <br />5.588624e-4 weeks <br />1.28609e-4 months <br />
4 (b) Recordkeepino Recuirements The facility licensee shall retain the redical documentation employee is employed in this capacity (perator while the for each lictnsed. operator and senior o 10 CFR 55.27). There are approximately 5000 licensed operators whose redical records need to be retained. This is en increase of 4000 from the current OMB submittal.
That subn.ittal only censidered new asplicants and did not consider operatcrs aircady licensed.
T1e annual recordkeepino burden per person is approximately
.10 hours1.157407e-4 days <br />0.00278 hours <br />1.653439e-5 weeks <br />3.805e-6 months <br />. Totalannualburdenis5000x.10hoursa 500 hours0.00579 days <br />0.139 hours <br />8.267196e-4 weeks <br />1.9025e-4 months <br />.
(c) Total Industry Cost and Burden 800 New Applicants X.25 hours2.893519e-4 days <br />0.00694 hours <br />4.133598e-5 weeks <br />9.5125e-6 months <br /> = 200 heurs X $0F = $18,400 500 Renewal Applicants X.25 hcurs = 125 hours0.00145 days <br />0.0347 hours <br />2.066799e-4 weeks <br />4.75625e-5 months <br /> X $92 = $11.500 50 Notices of Disability X.25 hours2.893519e-4 days <br />0.00694 hours <br />4.133598e-5 weeks <br />9.5125e-6 months <br /> a 13 hours1.50463e-4 days <br />0.00361 hours <br />2.149471e-5 weeks <br />4.9465e-6 months <br /> X $92 < $1,196 5000 Records Retained X.10 hours1.157407e-4 days <br />0.00278 hours <br />1.653439e-5 weeks <br />3.805e-6 months <br /> = 500 hours0.00579 days <br />0.139 hours <br />8.267196e-4 weeks <br />1.9025e-4 months <br /> X $92 = $45,000 Totc1 annual industry burden is 838 hcurs. Total annual industry cost is $77,096.
14.
Reasons for Change in Purden The burden estimated here represents en increase of 350 bcurs over the annuel industry burden estimated under the current clearance. This increase is due to the inclusion of the-renewal applicant certificaticn submittels, notifications of disability, and the maintenance of medical records fer all licensed operators.
15.
Publication for Statistical Use This information is net published for statistical use.
B.
COLLECT 10t;S OF INFON% TION EMPLOYING STATISTICAL ~ METHODS-Statistical methods are not used in the collection of information.
Enclosure:
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CERTIFICATION OF MEDICAL EXAMINATION he-i m i MM(/
D BY FACILITY LICENSEE ms4 NAME Of APPLICANT F ACIUTY FACUTY DOCrtT NUMBER
- 1. MEDICAL EX AMIN ATION CERTIFICATION THIS IS TO CERTIFv THAT THE ABOvi NAMED APPUCANT FOR AN OPER ATCA SENIOR OPES <& tC.H UCENSE
- AS et EN Eit AMINL C et A pwv Sic;AN PRINTED NAME voi pe scens ST ATE AND UCENSE NUMBLR EX AMA AT!ON D Af t r
BASED ON THE RESULTS OF THE EXAMINATION INCLUDING IN8DAMATION SURN'SHto ev Tut APPUC ANT *Hf emSCAN wAS DETIPMINED Tw AT THE APPUCANT'S PHv$iCAL CDNDITION AND GENERAL Mt ALTH ARE NOT SUCH TN A T l' VIGHT C AUSE Opta AfiDNAL tcRos s ENDANGle.iNG PUBUC HE AL TH AND SAFETY I CERTIFY TH AT IN REACHING TH!$ CITERMIN ATION Twt GJfDANCE CDNTalNED IN ANSI ANS 3 a uig3 op ANS3 ANS 35 4 3977 N330, a A3 FOLLOWED AND THAT DOCUMENTATION IS AvaiLABLE FOR RivitW BY AliC ON THE BASIS OF THE RECOMMENDATION Of THE PHYSICIAN I RECDMYENDED TH AT THE APPUCANT $ DPER ATDR'S UCENSt BE CONDITIONED AS FOLLOWS.
NO RESTRICTIONS I
CORRECTIVt LtN$t$ Bt WORN WHEN PERFORMrNG LICENSID DUTitS HEARING aid BE WORN WHEN PERFORMING UCENSID Dutits RESTRICTED LICENSE OR EXCEPTION #Sucoortmo rnemeat emenre e errachno for N8C revie*i PROPOSED WORDING OF RtSThictl0N Rtt.AflON5 hip OF RESTRICTIDN TO DISQU AUFYtNG CONDITION dbne te morrere hoa restnction ww cor ect tne pisouave mg wnoirem r
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- 2. NONMf DICAL CERTIFICATION THis CERTIFIES THAT THE APPUCANT HAS BEEN FOUND TO MEET THE SA8EGUARDS' REQUIREMENTS DF THis f ACluTY FOR LICENSID OPERATORS Any faise statement or omason m tne oocument inctuomo snacnments may to suinect to c=* eno commai sannons a cenitv unoer peneity o, periury tasi ine mvormaion a tms onevmem eno ensenmems is eme enn ent e-'
PRINTE D N AME AND SIGN AfUnt,se,wy Asaneuemen, merne nrer e ea se flT LE DATE 4$'
bbb in accoraance wven 10 CFR 455 6. Commumcatois the form sas41 de suomittee to the NRC as foisows BY MAIL ADDRESSED 70 V
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Regional Aomentetretor, Region i Regionai Aammistrator Regen il
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U.S. Nuclear Regulatory Commission U.S. Nucisar Resutatory Commission h.
475 Allencesa Reed 101 Manette Stront Suite 3100 y
King c f Prvesta. P A 19 A06 Atlanta. GA 3333
,i Rooonal Aomenstrator. Regen ill Regonal Aommetrator. Region IV Regonai Aommistrator. Regen V
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V $_ Nucieer Reguutorv Commesen U S. Nucmar Reguwtory Commessen U S Nucmar Requistory Comno o"
Wanut Crees. CAfvi6/g (/
1450 Mene Lane. Suite 210 790 Roosevelt Road 611 Ryan Ptara Onve Suite 1(X10 Glen Enym. IL 60137 Artmoton, TX 76011 PRIVACY ACT ST ATEMENT g
Pursuant to 6 U S C. SS:sieH3L enacted eto saw ey secten 3 of the Pnveev Act et ROUTINI U$ts. The mtormaton may te cinciosed to an anoroonste Federni. State
.$( 1974 iPubbc Law 93 $796. the following statement a tuitwshao to convutuais who supply or locai agency m the event tne moormaron moscates a vaston or potentia! volation information to the U.S. Nuclear Recuiatory Communen on NRC Form IWi TNs m!;tr-of law ano e tne event tne mtormation inoicates a vio4atoon or potemen vaation of law A*.
materEie matntained m a synmugyte oessaaW u NRC 4muf4cntes at av ano e tne course of an samanistretsvo or suaeces proceenmo m acoseon. tNs mtorma.
ton ensv tie t*ansierred to an approorste Feoerai. State, ano local agency 1 $ tne ettent
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YTeoers TequisiWIITTJctooer 1. 19 7bi-re. event ano necesserv tot en NRC cecison about you.
AUTHORITY Sectens 107 and 16tm of the Atomic Energy Act of 1954 as amenoso WHETHER D SCLOSURE IS MANDATORY OR VOt,UNTARY AND 18FtCT ON d42 U S C,2137 ano 2201W.
INDIVIDUAL OF NOT PROVIDING INFORM ATION Disemsure e v(sunta v if the re.
PRINCIPAL PURPOSEtSL Informenon entereo on the form e useo so oetermee weetne, Questac mtMm82 e not Drovced howevet 1%4 appucaten im a faMity p3ty 3 the phvwesi coenon and geners hearth of the appucant s's such that they wel not e nonce wator e license mav De oenas cause operaisonal errors enaanoermo pupac hearte rio safetv The mtormeten mov de used Dv the NRC statt to ostermms it the mosvious meets the rooveements et 10 CFR SYSTEM MANAGERISI AND ADDRESS Chef, Operator ucensmo Branch Onic, of 55 to tase an enerrenscon or to be neueo an operator s secense_
Nucisar Reactor Reguistiott U S. Nucesar Reguimiory commason. Washmgton, QC 20555 L37sM ATED evmDEN etR Rtt'ONSE TO comet.Y wrTM TM18 theOmMATiON COLLECTION RtQUtf7 25Het
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copw Am0 COMMENT 3 Rf G ARDiNQ SURDEN t$ttM Af t To TMS *ECORDS AND RipORTS MANAGEMENT an ANCH 8P 630t' 1
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EstiMAtto sumDth essi mispowse to toMety netw twis 66 77,64 35. L INF osmMa t ioh cottlet10N Pluut$1 26 Nitt 7 08
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DC Nt03 tout 06 APPLICANT F ACILITY lF ACILITT DOCAlf NUMBE R A. MEDICAL E XAMIN ATION CERTIFICATION THisl$ TO CERTIFY THAT THE ABOVE NAMED APPLtCANT FOR AN OPE RATOR'$tNIOR OPE R ATOR LICENSE H A5 Bt(N E KAMINED BY A PHYSICIAN.
FRlNTED NAME fof phrsicon) l$T ATE AND LICEN$t NUMBER l t R AMIN ATION D ATI 8AstO ON THE RESULTS OF THE E KAMINATION. !NCLUDING INFORMATION S URNf 5HE D By THE APPLICANT. THE PHY$iCI AN HA$ 04 it RMINED THAT THE APPLICANT'$ PHY$tCAL CDNDITION AND GENE R AL HE ALTH A RE NOT SUCH THAT IT MIGHT CAU$t OPE R ATION AL (RFiORS (NDANGE RINO PUOLIC HE ALTH AND SAF TTY. t CE RTIF Y THAT IN RE ACHING THIS Dtit RMIN ATION. THE GUID ANCE CONT AINE D IN ANSUAN5 3 41983, OR AN56/ANs 18 41977 (N3sa w AS FOLLowtD AND THAT DOCUMINTATION i$ AVAILABLE FOR RtvitW BY NRC.
ON THE BA$1S OF THE RECOMMENDATION OP THE PHY$1CIAN. I RECOMME ND THAT THE APPLICANT'$ 0PER ATOR LICENSI 8t CONDlfl0NtD A$
FOLLows:
- t. NO RESTRICTION $
- 2. 00RRECTlvt LIN5t$ Bt WORN WHEN PE RFORMING LICEN$tD 0UT185
- 3. HE ARING AfD Bt WORN WHEN PIRf 0RMING LICEN$10 DUTit$
- 4. AtST RICTED LICEN5t OR E xCEPTION Provee deteos t elow and setach suptortmg medical evdence for NRC review
- 6. R1$t RICTION Cr4ANGt F ROM PRt vlOUS $UBMITT AL.Previde deius t eiow est attoch supportmo me(col eveente los NRC sevien.
PROPO$t D WORDING 0F RISTRICTION (8/ ora d eoovel Rt LATIONSHIP OF REST RICTION TO DISOUALIF YING CONDITION (praprty awfcare how restruen west conect tr4 o,sounaspng comisren)
RtMARp.$ FOR HtSTRICTION CHANGL (8m 6 shovel it. NOfu". DICAL CLHilF ICATION THl5 CE RTiFits THAT THE APPLICANT HAS BtEN FOUND TO ettYtHE SAf tGUARDS AND FITNESS FOR DUTY REQUIREMENTS OF THIS F ACILI FOR LICENSED OPERATOR $
ANY $ A Las a t AtiMINt OH QMlb5 SON iN tMis DUCUWs hi, iNLLUDING. ti ACHMENt3 M AY es $U6Jtret 10 (lyib AND LMIMiNAL 6ANCt IVN1. 4 lim t18 v 4JNut 69 Pt NA4 t t W
$k%Julty THAT TH4 INeOmMat ch th THIS DOCUMENT AND A tt AcMME Nil il T mbi AND COsihtC1, PAINilD N AME AND $lO.^4ATURE (Saner Manspement Aeorosentersve on Sirel TIT Lt DATE in escreence with to CF A 66.6. Commun catens. the form ihot be submetied to the NRC As totiows:BY MAIL ADDRtSSED TO.
Regenal Admmistrator. Region 1 Regenal Admmistretor. Regen il Regions Adm mstrator Region lli UA Nuclear Regulatory Commissen U.S. Nuc6 ear Repistory Commessen U S Nuclear Requistory Commessen 476 Allendete Road 101 Manette street. Sutte 3l00 799 Roosevelt Road King of Prussis. PA 19406 Atlance. G A 30323 Glen tflyn. IL 60137 Dueet% Division of Licensee Performance Regional Admimstrator. Region IV Regional Actmmistrator. Region V er:10vanty twaiusuon U E. Nucinar Repetory Commessen U S. Nucisar Reguistory Commission Ann: Ope stor Licensmo eresch 611 Rysn Plate Dnve. Suite 1000 1460 Mene Lane. Suite 210 U $ Nuclose Regulatoey Commissen Arlington, TX 76011 Weinut Creek. CA 94596 Washmeon DC 206fA PRIV ACY ACT ST ATEME NT ROUTINE U$t$: The informse on may be d seiosed to en appropnete Federal State. or Punivant to 6 U.$.C. 662eleH3), enacted imo see by section 3 of the Privacy Act of s
1974 (Public Lam 93679).the followmg statement is 'urnished to individuals who 6 aces egency m the event the information indicates a vioisten or potentist veoisten of ien supply informaten to the U.S. Nucisar Reguistory Commission on NRC Form 396 and in the event the information mdicatet a violaten or potential violaten of Ise and in This entormation is mamtamed m a system of recoros oesignated as NRC 18 and the course of en oderwnstrative or sudicia! proceedme in etiditen tha mformaten mov be emaiad si 6e eewei fieeiw 33978 4A4,e Jo. ieoot transferred to en sporopnote Fateret. State and local agency to the entent resevent end AUTHORITY: Sections 107 and 161(i) of the Atomic Energy Act of 19#4. es necessary for en NRC oocesion ateut you WHtTHER OtSCLOSURE is MANDATORY OR YOLUNT ARY AND (FFECT ON amorced i42 U S C. 2137 emf M01(4)
INDIVIDUAL OF NOT PROvlDING INFORMATION. 04ciosure a voluntary. If trw PRINCIPAL PURPOSt($1: Informeten entered on thu form is used to determme requested informaten is riot proveed. however, the sophcaten for e tecility operstor's whether the physical conditen and general heaeth of the appucant are such that they will not cause operstonet errori endammenng pubhc hearth and safety. This mtorms or sener eterstor's hcense may be demed ten may be used by the NRC staff to oetermine if the individual meets the require $YSTEM MANAGERISi AND ADDRESS-Chief. Operstor Licensme trench. Omco of ments of 10 CF R 66 to take sei saammsten or to be issued on overstor's license Nuclear Reactot Repilation. US Nuclear Requietory Commissen. Weshmpon. DC 20666 8eAC FORM Jos ito 001
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