ML20033C743

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Request for OMB Review & Supporting Statement Re NRC Form 2, Application for Source Matl License, 10CFR40.31.Estimated Respondent Burden Is 600-h
ML20033C743
Person / Time
Issue date: 11/17/1981
From: Donoghue D, Scott R
NRC OFFICE OF ADMINISTRATION (ADM)
To:
Shared Package
ML20033C742 List:
References
NUDOCS 8112040067
Download: ML20033C743 (7)
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Text

y REEUEST FOR CMB REVIEW E~

(Und:r thJ Paperwork Reduction Act and Executiv? Ord:r 12291)-.

r Imp'ortant - Read instructions (SF-83 A) before completing this Office of Information and R:gulat:ry Aff airs f'

form. Submit the required number of copies of SF-83.together Office of Management and Budget with th3 material for which review is requested to:

Washington. D.C. 20503

1. Depart ner / Agency and Bureau / Office originating request
3. Name(s) and telephone number (s) of person (s) who can best answer questions regarding request -

U.S. Nuclear Regulatory Comniission Ve Miller (301) 427-4002 ->

2.6-digst Agency / Bureau number (firstpart of 11-digit Treasury

4. 3-dugit f unctional code (last part of 11-digit Treasury Account Acccunt No.)

No.)

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5. TstlJ of Information Collectson or Rutemaking C. Is this a rulemakang submsssoon under Section 3504th) of P.L.96-511 ? (Check one) h Application for Source Material License i q No tsection 3so7 submission) -

10 CFR 40.31 L -

20 Yes. NPRM. Expected date of iiublication:

~ 6. A.'Is cnyinformation coIIection (reporting or recordkeeping)-

30 Yes.tinalrule. Expected dateof pubiscation;

  • 'inv:lved? (Check one)

Effective date ~~

D. At what phase of rulemaking is this submission made?. _,,

Ig Yes and proposal is attache:1 for review

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1 q Not applicable Q

b Ar3 the responcents primarily educationalagencies or 20 Major rule,at NPRM stage

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P mstitutions oris the purpose related to Federal education 3 O Maior Final rule for which no NPRM was pud %shed

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4 O Major Final rule, after publication of NPRM O fus q No 5 O Nonmajor rule. at NPRM stage 6 O Nonmajor rule, at Final stage COMMETE SHhED PORTION IF INFORM ATION COLLECTION PROPOS AL IS ATTACHED

12. Agencyreport form number (s)h'N&

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7. Currsnt (or former) OMB Number

' 8. Requested Expiration Date '

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NRC Fnrm 7 S.Expir; tion D_ateM-Mhjn 13.,Are respondents only Federalagencies? :

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8112040067 811118 Standard Form 83 (Rev.3-81)~

j PDR ORG EUSCMB For use seg nning 4/1/81 v

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Ttl. bstract-Needs cnd Uses ($0 words crNss)

Y Applications for sp;cific lic nses for possession and u:e of's'otirce material shall be filed L

on NRC Form 2

78. Rel_t;d report f orm(s) (give OM8 number (s),lRCNfs);&
20. Catalog of Federal Domestic Assistance Program Number A.lnt:Jn*Iagency report form number _(s) or symbol (s)b5~~Q _,

N/A 21.Small business or organization O Yes Q No 19.Typ3 of affected public (Check as many as apply)

22. Type of activity of affected public-indicate 3-digit Standard industrial Classification (SIC) code (s) (up to 101 - if over 1 O Individuals orhouseholds 10, check O Multiple or O All

_ 2 O st:te orlocalgovernments 3 0 farms "4 Q businesses or otherinstitutions (except farms) 9 R 1 23.Brief d*;scription of affected public (eg,"retailgrocerystores."" State education sgencies,""householdsin 50 largest SMSAs")

'NRC licensees l24. Purpose (Check as many as apply. lf more than one. indicate 26.:Collectiorihiethod VCjecNijinaQ]ijd))W-Y- @

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27. Collection agent (Check one) e 25.Frsqu ;ncy of Use 1 O Nonrecurring 1)CX requesting Department / Agency Recurring (Check as many as apply),

2 O other Federat Department / Agency "2 p on occasion 6O semiannually 3 O private contractor-

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in supporting statement.)y '.. T.O Y,es,)CX No_

O 31.Will the proposed information collection create a new or Atomic Energy Act of 1954, as amended become part of an existing Privacy Act system of records? -

29. Rssoondent's obligatnon to reply (Check as many as apply)

(If yes. attach Federal Re mster notice or proposed dratt of 1 O voluntary not3ce.)

" Yes X No 2 O rsouired to cbtain or retain benefit

32. Cost to Federal Government cf 3 { mandatory-cite statu,1,e._not CFR (attach copy of..

information collection or rulemaking S20,000

' statutory authority)

COMPLETE ITEMS 33 THRU 35 ONLYIF RULEM AKING SUBMISSION

33. Compliance costs to the public i 34. is there a regulatory impact
35. ls there a statutory or judicial analysis attached?

ocadline affecting issuance?

5 0 Yes-0 No O Yes. Enter date-0 No C:!RTIFICATION BY AUTHORIZED OFFICI ALS SUBMITTING REQUEST-We certify that the information collection or rulemaking submitted for revtew as necessary for the proper performance of the agency's f unCitons.that the proposal represents the minimum public burden and Federal cost

' COnststent with f*eed, and is CoMestent with ?pplicable OMB and agency policy directives. Signature and title of:

AM9toviNG POLICY OFFIClaL F084 AGENCY DATE sutwTTING OFFIClAL -

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(pl Dania J. Donog e R. S Sc t b

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1 SUPPORTING STATEMENT FOR NRC FORM 2, Application for Source Material license 10 CFR 40.31 e

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W oustification Section 40.31 of 10 CFR Part 40' specifies that applications for specific licenses for possession and use of source' material.shall be filed on NRC Form 2.

The NRC Form 2 is intended as a mechanism whereby applicants may provide

,the information needed for review by NRC in order -to determine if a license

'should be issued.

1 The form will be used by an applicant to provide his/her name and address, location at which the source material will be possessed or used, the name of the person who should be contacted concerning the application, the purpose for which the source material will be used, the type, chemical and physical form, and the quantity-of source material which would be pessessed or used. The form includes the need for a description of the chemical, physical, metallurgical, or nuclear processes; the names and. technical qualifications of supervisory p;

personnel and the person responsible for the radiation safety program; the facilities and equipment which will be available ;for the operations to be carried out; calibration of instruments; ventilation equipment for operations which would produce dust, fumes, mists, or gases; radiation safety procedures for the operations to be conducted; and procedures for' disposal of wastes.

For applicants seeking licenses to distribute products to persons exempt from licensing, NRC Form 2 requires that information relating to the products, including percent of source material and location in the products; a physical description of the products and characteristics; radiation levels; and methods of assuming that the source material cannot be disassociated from the product provided.

The information submitted by applicants is reviewed by NRC to determine if the applicants' qualifications relative to training and experience, equipment availability, facilities, and procedures to use the source material for the purpose requested is such that the danger to life or proberty is minimized and the public health is protected.

If the information provided is adequate, a license will be issued.

There is no other source for the data.

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~ Description of Survey Plan Th'ere are approxfinately 3,00 source material licenses in the universe.

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Tabulation and-Publication Plans Documents are avai?able for public review at the Public Document Room, '

. 1717 H St. N.W., Washington, D.C.

20555.

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Time Schedule for Data Collection and Publication

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Applications are received at least 9 months prior to commencement of the requested activity to allow proper processing and verification.

Consultations Outside the Agency No consultations have been initiated since the last clearance.

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Estimate of Respondent Reporting' Burden-3 There are approximately 300 source material licenses currently in effect.

The licenses are issued for five-year terms.

Each year approximately 60 applications for renewal and 15 new applications are received. The preparation of a new application or application for license renewal requires an average of 8 hours9.259259e-5 days <br />0.00222 hours <br />1.322751e-5 weeks <br />3.044e-6 months <br /> of effort for completion. The total estimated burden is 600 hours0.00694 days <br />0.167 hours <br />9.920635e-4 weeks <br />2.283e-4 months <br /> annually.

Estimate of Cost to Federal ~ Government Approximately 500 professional hours per year are required for review and processing for a cost of $20,000.

Enclosure:

NRC Form 2 7.,

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/:Pt 10 CF0 <0 U.S. NUCLEAR REGULATORY COMMG310N

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INSTRUCTIONS FOR PREPARATION OM y

APPLICATION FOR SOURCE MATERIAL LICENSE FORM NRCa

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GENERAL INSTRUCTIONS

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I. An applicant for a Source Materis! License should complete FormgRC in detail.

e completed applicatbn must be filed in N.

quadruplicate with the Director of the Division of Fuel Cycle and Material Safety, Office o Material Safety and Safeguards, U.S. Nuclear QJ%

Regulatory Cen:ssion Washington, D.C.,20555. Applications may also be finco in person at the Commission's Office at 171711 Street

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N.W., Washington, D.C., or the Commission's office at 7915 Eastern Avenue, Silver Spnng, Maryland. -

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, M.".m The information required to complete Ch must be typewritten or printed clearly in ink.

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2. The regulations which govern the issuance of a Source Material Liunse are contained in Title 10, Code of Federal Regulations, Chapter 1 Part 40.

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3. An applicant may incorporate by reference information contained in previous applications, statementsir reports filed by the applicant with

%j M[,F the Commission's Division of Fuel Cycle and Material Safety, NMSS: Provided, that such references are clear and spe:ific, and there has

' " M been no change from the information previously submitted. In order to be clear and specific, the applicant should indicate by date, page, E

and paragraph what information is to be referenced and how such information is applicable to the license application.

' ' ~ 2.' Supplemental sheets t ould be used when necessary to supply the required information. The applicant's name and address and'th$ item

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h g umber in Form /NRC/2 to whic'. the supplementalinformation applies should be indicated on each supplemental stject.

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5. The Commision may at any time after the filing of the original application, and before the expiration of the limnse, require further i

statements in order to enable the Commission to determine whether the application should be granted or denied or whether a license should r

be modified or revoked.

6. Information and documents submitted to the Commission to complete an application will be made available for public inspection in accordance with the provisions of the Commission's regulations in Title 10 Code of Federal Regulations, Chapter 1 Parts 2 and 9.
7. Information which is classified as Restricted Data or which the applicant requests be withheld from public disclosure must be submitted in accordance with the provisions of Section 2.790,10 CFR 2," Rules of Practim.
8. Item 15 must be completed on allapplications.
9. Submisuon of an incomplete application will result in a delay in the processing of the application becue of correspondence necessary to request the omitted information.

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10. NRC RegulatoryGuide 10.4 contaats additional information regarding Commission regulations applicable to the use of source material AkJ A copy of the guide may be obtaiaed from the address specified abovel g."

PRIVACY ACT STATEMENT

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Pursuant to 5 U.S.C. 552a(c)(3), enacted hto law by section 3 of the Privacy Act of 1974 (Public Law 93-579), the following statement is furnished to indivi6 als who supply information to the Nuclear Regulatory Commission on l ormNR_Ch.This information is maintained in a system of records designated as hRC.32 and described at 40 Federal Register 45346 (October 1,1975).

1. AJrilORITY Sections 53,63, and 161(b) of the Atomic Energy Act of 1954, as a nended (42 U.S.C. 2073,2093,2201(b)).
2. PRINCIPAI PURPOSE (5) The information is evaluated by the NRC staff pursuant to criteria contained in 10 CFR Part 40 to determine whether the application meets the requirements of the Atomic Energy Act of 1954, as amended, and the regulations of the NRC, and w hether a source material license, or amendment or renewal thereof, should be issued to the applicant.
3. ROUTINE USES The information may be used: (a) To provide records to State health departments for their information and use;and (b)

To provide information to other Federal, State, and local health officials 'n the event of incident or exposure, for purposes of ' heir information, investigation, and protection of public health and safety. The information may also be disclosed to an appropriate Federal, S tate, or local agency in the event the information indicates a violation or potential vn.lation of law and in the course of an administrative or judicial proceeding. In addition, this information may be transferred to an appropriate Federal State, and local yency to the extent selevant and necessary for a NRC decision or to an appropriate Federal agency to the extent relevant and necessary for that agency's decision about you. Furthermore, in accordance with 10 CFR 2.790 of the Commission's regulations, the information is available for public inspection and copying.

4. UllETiiER DISCLOSURE IS MANDATORY OR VOLUNTARY AND EFFECT ON INDIVIDUAL OF NOT PROVIDING INFORMA.

TION It is voluntary that you furnish the requested inforrnation. If the requested information is not furnished,however, the application for a source material license, or amendment or renewal thereof, may be denied.

YE,' SYSTEM MANAGER (S) AND ADDRESS Directm, Division of Fuel Cycle and Material Safety, Office of Nuclear Material Safety and

,1j Safeguards, U.S. Nuclear Regulatory Commission, Washington, D.C. 20555.J -

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' m. W PLEASE REMOVE THIS INSTRUCTION SHEET BEFORE SUBMrITING APPLICATION '

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-0 p3 to cFR do U.S. NUCLEAR REGULATORY COMMISSION

^A PW APPLICATION FOR SOURCE MATERIAL LICENSE Pursuant to the regulations in Title 10, Code of Federal Regulations, Chapter 1. Part 40, application is hereby made for a license to receive, possess, use, transfer, deliver or import into the United States, source material for the activity or activities described.

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D (a) New license' e

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(d) Previous License No.

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4. LTATE THE ADDHESS(ES) AT WHICH SOURCE MATERIAL WILL BE POSSESSED OR USED
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3 6NAME OF Pk RSON TO BE CONTACTED CONCERNING THIS APPLICATION

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0. ST A T E T H E T YPE OR T YPES. CetEMsCAL FORM OR FORMS. AND QUANTITIES OF SOURCE M AT ERI A L VOU PROPOSE TO RECEIVE.

POSSESS. USE. OR T R ANSFER UNDER THE LICENSE (a) TYPE (b) CHEMICAL FORM (c) PHYSICAL FORM (Including (d) MAXIMUM AMOUNT AT

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(3) M A ME MUM TOT AL QUAN T4T Y OF SOURCE M AT ERI AL YOU WIL*. HAVE ON MAND AT ANY TIME [kdograms) 9 DESCRIBE T HE CHE MIC AL. PHYSICAL. M ET ALLURGICAL. OR NUCLEAR PROCESS OR PROCESSES IN WHICH THE SOURCE M ATERIAL WILL S E USED. GNDIC A TING T HE M A XIMUM A MOUNT OF SOURCE M ATERI AL 8NVOLVED IN EACH PROCESS AT ANY ONE TIME. AND PROVIDING A T HOROUGH EV ALU ATION Or T H E POTENTI AL H ADI ATION H AZARDS ASSOCA AT ED WITH EACH STEP OF THOSE PROCESSES.

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10. LIST THE N AMES AND ATT ACH A RESUME OF THE TECHNICAL QUALIFICATIONS INCLUDING TRAINING AND EXPERIENCE OF APPLICANT'S SUPE RVISORY PE RSONNEL AND THE PE RSON RESPONSIBLE FOR THE R ADI ATION SAFETY PROGRAM (OR OF AP.

PLICANT IF AN INDIVIDU AL).

~;Q tt. OF%CRIBE Y HE t.OUIPMENT AND F ACILeTaES WHICH WILL BE USED TO PROTECT HEALTH AND MINIMl2E DANGER TO LIFE OR PROPERTY AND Rt LAT E T HE U%E OF THE EQutPMENT AND FACILITIES TO THE OPERAT60NS LISTED IN STEM 9;8NCLUDE:(e) RADIATION DETECTION M U-LND Hf L Al LD ONST RUMENTS (meludeng Elm badgee. dosimeters. counters, mir semphag, and other survey equipment es appropnete. 'The desenption of W

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-e vedention detection sneaumente should inctis:le the snetrument cherecterestico euch as type of radiation detected,wiedewr thsekness. and the range (s) of each la-ys,

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13. DESCRISE PROPOSED PROCEDURES TO PROTECT HEALTH AND MINIMlZE DANGER TO LlFE AND PROPERTY AND R (a) SAFETY FEATURES AND PROCEDURES TO AVolO NONNUCLEAR ACCl-INCLUDE:

CEDURES TO THE OPERAYtONS LlSTED IN ffEM 9:

DEN f S. SUCH AS FIRE. EMLOSION. ETC $N &OURCE MATERIAL STORAGE AND PROCESSING AREAS.

(b) EMERGENCY PROCEDURES IN THE EVENT OF ACCIDEN F S WHtCH MiGHT af4VOLVE SOURCE M A(ERIAL.

(e) DEf AILED F

,JRIPTION OF RAOIAflON SURVEY PROGRAM AND PROCEDUHES e t WASTE PRODUCTS: !! none vill be generated, state **None** opposite (a). below. It waste products will be doner-ated, check here Q and explits on a supplemental sheet:

(a). Qcantity and type Of radioactive waste that will be generated.

(b) Detailed procedures for waste disposal.

to. IF PRODUCTS FOR DISTRIBUTION TO THE GENERAL PUBLIC UNDER AN EXEMPTION CONTAINED IN MANUFACTURED. USE A SUPPLEMENTAL SHEET TO FURNISH A DETAILED 10 CFR 40 ARE TO BE DESCRIPTION OF THE PRODUCT. INCLUDING:

(a) PERCENT SOURCE MATERI AL IN THE PRODUCT AND ITS LOCATION IN THE PRODUCT.

(b) PHYSICAL DESCRIPTION OF THE PRODUCT INCLUDING CHARACTERISTICS. IF ANY, THAT WILL PREVENT INilALATION OR INGESTION OF SOURCE M ATERI AL T H AT MIGHT BE SEPARATED FROM THE PRODUCT.

(c) BETA AND BETA PLUG G AMM A R ADIATION LEVELS (Specify instrumerit used, date of calibration and calibration technique used) AT THE SURFACE OF THE PRODUCT AND AT 12 INCHES.

(d) METHOD OF ASSURING THAT SOURCE MATERIAL CANNOT BE DISASSOCI ATED FRO UFACTURED PRODUCT.

CERTIFICATE (This itene snust be completed by applicant)

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certify that this application is vsreparEd in confortnity with Title 10, Code of Federal Regulations, w* ' W Part 40, and that allinfortnation contained herein, including any supplernents attached hereto,is true and correct to the best of our knowledge and belief.

L BY:

(Signature)

Dated (Prmt or type name) s reste et se,estyong otrisoal autho,esed to act on behalf of the apptocanta W AltNINUt 18 l'.SE. Sectiod l001: Act of June 2*.1918: 62 Stat.749: maker it a criminal agense to make a willfully false state.

ment or representatiott to any department or agency of the United States as to any matter within its jurisdiction.

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