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Request for OMB Review & Supporting Statement Re NRC Form 396, Certification of Medical Exam by Facility Licensee. Estimated Respondent Burden Is 425 H
	ML20057F454
Person / Time
Issue date:	10/13/1993
From:	Crawford G; NRC OFFICE OF INFORMATION RESOURCES MANAGEMENT (IRM)
To:	;
Shared Package
ML20057F455	List: ML20057F454; ML20057F457;
References
	OMB-3150-0024, OMB-3150-24, NUDOCS 9310180023
	Download: ML20057F454 (8)
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SUPPORTING STATEMENT FOR NRC FORM 396. " CERTIFICATION OF MEDICAL EXAMINATION BY FACILITY LICENSEE" 10 CFR PART 55. SECTIONS 55.23. 55.25. 55.27. 55.31 AND 55.57 (OMB CLEARANCE NO. 3150-0024)

EXTENSION i

DESCRIPTION OF THE INFORMATION COLLECTION 10 CFR 55.23 requires that the facility licensee certify the medical fitness of an applicant or licensee by completing and signing Form NRC 396.

10 CFR 55.25 requires the facility licensee to notify the NRC within 30 days if a licensee develops a condition that causes the licensee to fail to meet the requirements of 55.21.

For conditions where a conditional license is requested, the facility licensee must provide medical certification cn Form NRC 396.

10 CFR 55.27 requires that the facility licensee document and maintain the j

results of medical qualifications data, test results, and each operator's or senior operator's medical history for the duration of the operator's or senior operator's tenure and to provide the documentation to the Commission upon request.

10 CFR 55.31(a)(6) requires applicants for a license to provide certification by the facility licensee of medical condition and general health on Form 396 to comply with 55.21, 55.23 and 55.33(a)(1).

i 10 CFR 55.57(a)(6) requires applicants for renewal of a license to provide certification by the facility licensee of medical condition and general health of the applicant on Form NRC 396.

10 CFR Parts 26 and 73 specify fitness-for-duty and safeguards requirements that licensed operators must meet.

In addition to the medical examination certification, NRC Form 396 requires certification that the applicant has been found to meet the fitness-for-duty and safeguards requirements i

The clearance extension request does not amend the information collections, i

but merely increases the burden because of an estimated increase in the number of license renewal submittals.

A.

JUSTIFICATION 1.

Need Tor the Collection of Information Currently, the medical requirements of 10 CFR 55, " Operators' Licenses," requires an applicant to be examined by a licensed medical practitioner who will use guidance provided by ANSI /ANS E

3.4-1983 as endorsed by NRC Regtlatory Guide 1.134. The licensed 1

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_2-medical practitioner submits his/her diagnostic report to the facility licensee. The facility licensee, based on the data provided, certifies on NRC Form 396 whether or not the applicant is healthy enough to prevent operational errors endangering public health and safety.

In cases where the applicant for an operator's license or renewal does not meet the medical requirements or after recovery from a disabling condition, the facility licensee shall submit supporting medical evidence for review by the NRC consultant examining physician. The NRC and the consultant physician will review such F

evidence and decide if a conditional license or reinstatement from the disability shall be approved.

2.

Agency Use of Information The NRC uses the information as part of the basis for determining the fitness of an individual for licensing as a Reacter Operator or Senior Reactor Operator.

3.

Reductior of Burden Throuch Information Technolooy There is no legal obstacle to the use of information technology.

Moreover, NRC encourages its use.

4.

Duplication with Other Collections of Information This information does not duplicate nor overlap other information collections made by the NRC.

The Information Requirements Control Automated System (IRCAS) was searched, and no duplication was found.

5.

Effort to Use Similar Information The information is available only from facility licensees for each applicant for an operator license, new and renewal.

No similar information exists.

6.

Effort to Reduce Small Business Burdtn This information collection does not involve any small businesses.

7.

Consecuences of less Freouent Collection Information is to be provided only upon request for issuance of a license, renewal of a license (every six years) or upon notification to NRC of disability.

Frequency of reporting cannot be reduced without endangering the health and safety of ti.e public.

. 8.

Circumstances which Justify Variation from OMB Guidelines The medical records required by 10 CFR 55.27 are retained while an individual performs the functions of an operator or senior operator.

This information is used to determine whether the physical. condition and general health of operators and senior operators is such that it would not be expected to cause operational errors endangering public health and safety.

9.

Consultation Outside the NRC l

There have been no formal consultations outside the NRC regarding this form.

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10. Confidentiality of Inforvstion NRC 16, System of Records, specifies confidentiality of these records. These records are limited to those persons whose official duties require such access.

11. Sensitive Ouestions i

The facility licensee must certify that an applicant for an NRC l

operators license meets the facility medical fitness requirements to be licensed as an operator at the facility, form 396 also requires certification that applicants meet fitness-for-duty and safeguards requirements for unescorted access to vital areas of a nuclear power j

plant. This latter certification requires knowleoge of an applicant's drug testing results and a facility review of the applicant's criminal 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 1700 certificates will be submitted annually during the clearance period. Also, it is estimated that 100 of these certificates will be required to be reviewed by the NRC Consultant Physician and would require approximately two hours review each. Total Federal Government cost includes the following:

NRC Consultant Examining Physician:

100 certificates annually x 2 hours2.314815e-5 days 5.555556e-4 hours 3.306878e-6 weeks 7.61e-7 months each - 200 hours0.00231 days 0.0556 hours 3.306878e-4 weeks 7.61e-5 months @ $52.02/ hour - $10,404.

Initial and final staff review:

1700 x.2 hours2.314815e-5 days 5.555556e-4 hours 3.306878e-6 weeks 7.61e-7 months - 340 hours0.00394 days 0.0944 hours 5.621693e-4 weeks 1.2937e-4 months x $132

- $44,880.

Total annual cost to the government is $55,284.

This cost is fully recovered by fee assessments to NRC licensees pursuant to 10 CFR Part 171.

. 13. Estimate of Industry Burden and Costs (a) Reportino Reouirements i

Approximately 800 new and 850 renewal applicant certifications are expected to be completed by facility licensees annually.

Approximately 50 notifications of disability are also expected annually. The estimated annual reporting burden per applicant is i

.25 hours2.893519e-4 days 0.00694 hours 4.133598e-5 weeks 9.5125e-6 months .

j 800/New Applicants x.25 hours2.893519e-4 days 0.00694 hours 4.133598e-5 weeks 9.5125e-6 months = 200 hours0.00231 days 0.0556 hours 3.306878e-4 weeks 7.61e-5 months 850/ Renewal Applicants x.25 hours2.893519e-4 days 0.00694 hours 4.133598e-5 weeks 9.5125e-6 months = 212.5 hours5.787037e-5 days 0.00139 hours 8.267196e-6 weeks 1.9025e-6 months 50/ Notices of Disability x.25 hours2.893519e-4 days 0.00694 hours 4.133598e-5 weeks 9.5125e-6 months = 12.5 hours5.787037e-5 days 0.00139 hours 8.267196e-6 weeks 1.9025e-6 months i

Total annual burden is 1700 x.25 hours2.893519e-4 days 0.00694 hours 4.133598e-5 weeks 9.5125e-6 months = 425 hours0.00492 days 0.118 hours 7.027116e-4 weeks 1.617125e-4 months .

)

(b) Recordkeepina Reauirements The facility licensee shall retain the medical documentation for each licensed operator and senior operator while the employee is employed in this capacity (10 CFR 55.27). There are approximately l

5000 licensed operators whcse medical records need to 3e retained.

1 The annual recordkeeping burden per person is approximately.10 hours1.157407e-4 days 0.00278 hours 1.653439e-5 weeks 3.805e-6 months . Total annual burden is 5000 x.10 hours1.157407e-4 days 0.00278 hours 1.653439e-5 weeks 3.805e-6 months = 500 hours0.00579 days 0.139 hours 8.267196e-4 weeks 1.9025e-4 months .

(c) Total Industry Cost and Burden f

800 New Applicants x.25 hours2.893519e-4 days 0.00694 hours 4.133598e-5 weeks 9.5125e-6 months = 200 hours0.00231 days 0.0556 hours 3.306878e-4 weeks 7.61e-5 months x $132 = $26.400 850 Renewal Applicants x.25 hours2.893519e-4 days 0.00694 hours 4.133598e-5 weeks 9.5125e-6 months = 212.5 hours5.787037e-5 days 0.00139 hours 8.267196e-6 weeks 1.9025e-6 months x $132 =

$28.050 50 Notices of Disability x.25 hours2.893519e-4 days 0.00694 hours 4.133598e-5 weeks 9.5125e-6 months = 12.5 hours5.787037e-5 days 0.00139 hours 8.267196e-6 weeks 1.9025e-6 months x $132 =

$1.350 1

5000 Records Retained x.10 hours1.157407e-4 days 0.00278 hours 1.653439e-5 weeks 3.805e-6 months = 500 hours0.00579 days 0.139 hours 8.267196e-4 weeks 1.9025e-4 months x $132 = $66 000 Total annual industry burden is 925 hours0.0107 days 0.257 hours 0.00153 weeks 3.519625e-4 months . Total annual industry cost is $122.100.

14. Reasons for Chance in Burden The burden estimated here represents an increase of 87 hours0.00101 days 0.0242 hours 1.438492e-4 weeks 3.31035e-5 months over the annual industry burden estimated under the current clearance because of an increase in the anticipated number of renewal certification i

submittals. However. the current SF-83 erroneously included an additional 287 hours0.00332 days 0.0797 hours 4.74537e-4 weeks 1.092035e-4 months for reporting above that reflected in the i

accompanying supporting statement. This error is being corrected in i

this submittal resulting in an overall decrease in burden of 200 hours0.00231 days 0.0556 hours 3.306878e-4 weeks 7.61e-5 months .

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15. Publication for Statistical Use This information is not published for statistical use.

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COLLECTIONS OF INFORMATION EMPLOYING STATISTICAL METHODS l

Statistical methods are not employed in the collection of information.

Enclosure:

NRC Form 396 i

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e NRC FORM 396 U.S. NUCLEAR REGULATORY COMMISSION APUROUED BY OMS: NO. 3tto 6934 (144}

10 CFR SS.23. 5S25, E ST7 MATED BURDEN PER RESPONSE TO COMPLY W'TH THts INFORMATON CDLLE', TON REQUEST: 95 MINUTE!L NRC REQU6RES

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SS2?, SS.31,59 33 THIS INFORMATON TO DE'tTRulNE THAT NE PHYSICAL CONDITON AND gg'$7 HEALTH OF OPERATOR UCENSEES IS ULC' THAT THE APPUCANT CERTIFICATION OF MEDICAL EXAMINATION woutD Not BE EXPECTED TO CAuSE OPERATONAL ERRORS ENDANGERING THE PUBUC HEALTH AND SAFETY.

FORWARD BY FACILITY LICENSEE COMMENTS REGARDING BURDEN EST1 MATE TO THE INFORMATON AND RECORDS MANAGEMENT BRANCH (MNBB T714),

U.S.

NUCLEAR REGULATORY COMMISSION, WASHfNGTON, DC 205554001, AND TO THE PAPE RWORK stEDUCTON PROJECT (3150-0c24). OF'FiCE OF MANAGEMENT AND BUDr1ET, WASHINGTON. DC 20Sc3.

NAME OF APPUCANT l F ACluTY DOCKET NUMBER F ACILrTV A. MEDICAL EXAMINATION CERTIFICATION TH!S LS TO CERTIFY TMAT THE A9OVE NAMED APpUCANT FOR AN OPERATOR / SENIOR OPERATOR UCENSE HAS BEEN f.XAMINED BY A PHYSICtAN.

PR!N'EO NAME (of physicsay l STATE AND UCENSE NUMBER E/ANhNA~'1CN DATE BASED ON THE RESULTS OF THE EXAMtNATION NCLUDING INFORMATON FURNISHED BY THE APPUCANT, THE PHYSCIAN HAS DETERMINED THAT THE A.8*UCANTE PHYSICAL CONDnON AND GENERAL HEALTH ARE SUCH THAT THE APPUCANT WOULD NOT BE EXPECTED TO CAUSE OPERATONAL ERRORS ENDANGENING PUBUC HEALYM AND SAFETY I CEFMW THAT IN FCACHING THIS DE'ERMtNATON, THE CUtDANCE CONTArNED IN ANSUANS3.4 1983.OR ANSI /ANS15 4-1968 (N380) W AS FOLLOWED AND THAT DOCUMEVATON IS AVAILABLE FOR FIEVIEW BYNRC F THE GUCANCE W THE APPROPRIA'E ANSI /ANS DOCUMENT IS NOT COMPUED WrrH AN ACCEPTABLE ALTERNATNE METHOD, WHICH HAS BEEN APPFOKD BY NRC, WAS

USED, ON THE Basis OF THE RECOMMENDATION OF THE PHYSICIAN, I RECOMMEND THAT THE APOLICANT'S OPERATOR LICENSE BE CONDITIONED AS FOLLOWS.

1. NO RESTRICTIONS

2. CORRECTIVE LENSES BE WORN WHEN PERFORMING LICENSED DUTIES

3. HEARING AfD BE WORN WHEN PERFORMING LICENSED DUTIES

4. RESTRICTED LICENSE OR EXCEPTION - Provide details below and attach supporting medical evidence for NRC review.

5. RESTRICTION CHANGE FROM PREVIOUS SUBMlTTAL - Provide detai!s below and attach supporting medicat evidence for NRC review.

PROPOSED WORDING OF RESmlCTION (Bloch 4 above)

RELATIONSHIP OF RES'RICTON TO DISQUAUWWG CONDmON IBreeef awfecere how resencDon elf correef the spsguaWymg conepon) e RE MARKS FOR RE STRtCTON CHANGE lBeock 5 arma) i B. NONMEDICAL CERTIFICATION THIS CERTiF LES THAT THE APPUCANT NAS BEEN FOUND TO MEET THE SAFEGUANDS AND FI' NESS FOR DU"Y REQU!REMENTS OF THIS F ACluT" FOR UCENSED OPERATORS.

ANY F ALSE ST ATEMENT OR OMG380N IN THIS DOCUMENT, INCLUDING ATTACHMENTS, MAY BE SUEUECT TO CML AND CRIMNAL SANCDONS. I CERTIFY UNDER PENALTY OF PENURY THAT 'HE INrORMATiON IN THIS DOCUMENT AND ITTACHMEN'S IS TRUE AND CORRECT.

PRN'ED NAME AND T'TLE (Serwor Menegement Begvesentenwe on Sne) l SIGNATURE lDATE in acCordance with 10 CFR 55 5, Communications, this form shall be submitted to the NRC as followS: BY MAIL ADDRESSED TO:

REGONAL ADMNISmATOR, ALGION 4 REGONAL ADurNISTRATOR, REGON 11 REGIONAL ADMIN lSTRATOR. REGION lli i

U.S. NUCLEAR REGULATORY COMMiSSON UA NUCLEAR REGULATORY COMMISSON U.S. NUCLEAR REGULATORY COMMiSSON 47$ ALLENDALE ROAD 101 MARIE *'A STREET NW, SUTTE 29rIO 790 ROOSEVELT ROAD KWG OF PRUSSIA PA 1943& tetS ATLANTA. GA 30323-0199 GLEN ELLYN. ll 60137-592T REGONAL ADMN!SmATOR. REGION IV REGONAL ADMN:S'RATOR, REGON v OPERA (OR UCENSNG BRANCH U S. NUCLEAR HEGULATORY COMMISSON U.S. NUCLEAR REQUULTORY COMutSSION DMSION OF REACTOR CON

rot.S 811 RY AN PLAZA DRNE. SU!'E 430 1450 MARLA LANE AND HUMAN FACTORS ARLINGTON. TK 7ecib8064 WALNUT CREEK, CA D45984068 U.S. NUCLEAR REGULATORY COMMiSSON WASHINGTON, DC 23555 OmM Na:C FOHM 396 (1441 PRINTED ON RECYCLED PAPER

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ML20057F454

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