ML20135E787

Request for OMB Review & Supporting Statements Re Current Occupational Radiation Exposure.Estimated Respondent Burden Is 124,740 H

ML20135E787
Person / Time
Issue date:	09/10/1985
From:	Norry P NRC OFFICE OF ADMINISTRATION (ADM)
To:
References
OMB-3150-0006, OMB-3150-6, NUDOCS 8509170032
Download: ML20135E787 (16)

Text

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< Pe.secrew .HP Request for DMB Reviea "f%= =>=

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Read instructions before completing form Do r'ot use the urne SF 83 Send three copies of this form. the material to be reviewed, adfor to request both an Executive Ori$ er 12291 review and accrovat under paperwork-three copies of the supporting statement, to the Paperwork Reduction Act.

Answer all questions m Part I lf this request is for review under E.O. Of fice of information and Regul. story Af fairs 12291, complete Part il and sign the regulatory certification if tnis Offece of Management and Budget

. request is for approval under the Paperwork Reduction Act and 5 CFR Attention: Docket Library. Room 3201 1320. skip Part 11, complete Part ill and sign the paperworm certificatioa Washington. DC 20503 PART l.-Complete This Part for All Requests.

1. Department / agency and Bu' eau.' office ortginatmg request

2. Agencycode U.S. Nuclear Regulatory Comission, NRC 5

3. Name of person ano can best ar' seer questions regarding this reqdst~

_1 _L 5_ 0_

Telephone number R. E. Baker Ut4 of information codection or ru+emalung (301 > 443-4579 Current Occupational Radiation Exposure S. Legal sathor<t1 for mtormation cortection or ruse (cite unored Srstes Code. Pubhc uw. or becutne Order) d? USC @ @ . or

6. Affacted pubhc(checa J!/ thateco4) s O red.,aiagenc.es or empiovees 1 C Indiv445 or househotos 3 0 ra,ms 6 0 non pro ,tinstitut,ons r

2 O stateoriocasgovernments 4 f2 eusmesses or other for proeit 7 T smais dus.nesses or organisations PARTli.-Complete This Part Onlyif the u ti r hv ebnder Executive Order 12291

7. Rrgulation identifier N amber (olN)

___ ~_ .. _ . or. None ass <gned O

8. Type of submissoon (check orse on each category)

Type of resten requested Classification Stage of developrnent 10 5tardard 1 O Maior i O proposed or d art 2 O pending 2 O nonma,o, 2 O rinat o, inter.m e>nai. witn prior proposai 3 0 cmergency 3 0 rinai or irsenm tinat. witnout pno, pron >sei 4 0 statutorvoraudiciaidesdiine

9. CFR section affected CFR

10. Does this regulation cor'tain reporting or recordbeeping requrr nents that reqaire OMB approval under the Paperworti Reduct.on Act ard 5 CFR 1320?

. _ _ O ves O No

11. If a ma;or rule, ss there a regulatory impact analysis attached' it No." did OM8 aaive the ana ysts?

1 O ves 2 O no 3 I Yes 4 0 no Certification for Regulatory Submissions in submittmg th.s request for OM8 revia *. the authoriteo ecgWatoer pol <y directives have been compi.e<f with enntact and the pr<sgram of ficia' r ertify that the seqwrements of [ 0 122M and any aophr.able Signatura of program of f<.at

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PA8tT lli.-Cernplet) This Ptrt Only if the Requist is for Apprtvil cf a Cell:cti::n c t Information Under the Paperwork Reduction Act and 5 CFR 1320.

13. Abstract-Descnbe needs, uses and affected pubhc in 50 words or less Licensees use NRC Form-5 data to assess and control ongoing radiation protection programs and to document to the NRC and the licensee's workers that their occupational doses have not exceeded applicable limits.

14. Type of iriformaten collection (chec4 only one) enformation coJ6es toone not contained ht rules 10 Reguiar suvnessen 2 O Eme<gency submessentcert.facationattached>

In#ernsation cokettiene centMned in ru6ee 3 0 tiet ng reguiaten(no charveproposed) s rina ormtenmimaiwitnooipno,neRM 7. Ente, daie of e.pected o, actuai rede,si 4 O Notice of proposed rulemahing(NPRM) A O Reguiar submission Reg ster pubiication at this stage of ruiemaking 5 0 Final. NPRM was pressously pr.okshed 6 0 Emergency submasson(certif caten attached) ('"o"th. a*r r**r)

15. Type of review requested (checa cory one) 1 O New coiiecte 4 O Reinstatement of a previous >y approved coiiecte for which appeovai 2 @ Revneon of a currently approved collecten **

3 O Extension of the expraten date of a currentry approved codlection 5 O Esisting cohecten m use without an ous controi number methout any char'ge in the substance or en the method of collection

16. Agency report form number (s)(aciude standard /optenal form number (s)) 22. Purpose of .nformation collection (check as many as apply)

NRC Form-5 1 O Apphaten for benefits

17. Annual reportmg or disclosure bu'*a 2 O erocamevaivation 3 0 ceneratpurposestatstics 1 Number c? respondents .

4 @ Regulatoryorcompience 2 Number of responses per respondent 5 O Prog am pianningor management 3 Totsi annual responses thne 1 times kne 2) 6 O Research 4 Hours per response 7 O Audit 5 Total hours (Ime 3 t,mes kne 4) 1g. Annuai recordheepng burden

23. Frequency of recordheepng or reportmg (checA all that apply) 1 Nurnber of recordaeepe,, 7,500 g g p ,,,,,,,,,,

2 Annual hours per recordkeeper. *

1. 8Perthw 3 Tot:4 recordmeeper,a hours (kne J t;rnes kne 2) 124s14U 2 O onoccasion 4 Recordkeepeng retente perws U f e year $ 3 O weekiy

19. Totalannual burden 4 O Montniy 1 requested (kne 17 5 plus kne 18 J) . 124,740 $ 0 overteriy 2 in current oMB mventory 6M,%7 6 0 semiannuasiy 3 Difference (kne J Jess 6ne 2) -551,927 y g gnno,,,,

tapeonetlen efdifference 8 O Bienniany 4 Program change 9 O otnertdescribe).

5 Adjustment -551,927

20. Current (most recent) oM B controi numtwr or comment number

24. Respondents'obegation tocomply(chech the strorwestobdqsafe therapplaes)

MfdLAAAA 1 O voeuntary

21. Requested espdatsoridaTe-2 O Required M obum or rehen a benefit September 1989 3 00 ua~w-y

25. Are the respondents pnmarily educateal agencies or institu' ens or es the pnmary purpose of the collection related to Federal education program

24. by Does the agenC use samphng to selert respnnrients or does the agency recommend or prescribe the use of sampling or statistical analyss respondents i 27. Reguiatory authority for the mformaten coliection

. . . O ves G No CFR  ; ov FR :or.other(sperity). 42 USC 220l f o)

E J. A Certification in subm.ttmg this request for oMB approval, the agercy head. the senior official or an authorised representative. certifies that the requirements of 5 CFR 1320 the Pervacy Act. statisticai standards or directives, and any other apphcable informaten pohcy directives have been cornphed with

$gnaturaof programo rficial oate I

s.gnato,a of agency head. tre sen,ur off c ai or n suenorised representative -

caie Patricia G. Norry 4 6 w' n// /w, 9WV F M CN) i 1 % 4 0 - M b 77ti

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SUPPORTING STATEMENT FOR o

NRC FORM 5 CURRENT OCCUPATIONAL RADIATION EXPOSURE

1. Description of the Information Collection NRC Form 5 is used as a current record of occupational radiation doses for each individual for whom personnel monitoring is required by 10 CFR Part 20.

Under the current OMB control number 3150-0006, NRC Form 5 has 676,667 total recordkeeping hours in the current OMB inventory.

NRC Form 5 is being revised tb reflect the recording of occupational radia-tion doses for each individual for whom personnel monitoring under normal operating conditions is required by revised 10 CFR Part 20, and all doses due to overexposures, planned special exposures, accidents, and emergency conditions, as reoufred by proposed S 20.1106.

Under the proposed revision, OMB control number 3150-0006 NRC Form 5, will request 124.740 total recordkeeping hours in the OM8 inventory.

The difference of 551,927 total recordkeeping hours is an adjustment based on NRC staff's judgment that NRC licensees will need 2 minutes for each of 3,600,000 entries per year rather than 10 minutes for each of 4,060,000 entries per year to maintain records of current occupational radiation exposure. The major reason for the reduced time per entry is the increased use of computers to maintain occupational dose records.

2. Justification NRC Form 5, or its equivalent, contains the information required by

$ 20.1106 which establishes that the licensee have records of assessment of external dose (55 20.202(a) and 20.502(a)), records of assessment of 1 Enclosure 2/ Addendum 4

internal dose resulting from intakes by all significant routes of intake

($$ 20.202(b), 20.204(a), (c), (d), (h)(2), 20.205(b)(5), 20.206(h),

20.502(b), and 20.703(a)(2)(ii)), and records of the summation of external and internal dose as effective dose equivalent.

a. Need for the Information Collection It is essential that licensees maintain records of the occupational doses of their employees in order to establish whether these doses have exceeded the limits. Dose records are important also for assess-ment and control of ongoing programs, particularly with respect to maintaining occupational exposures as low as is reasonably achievable and identifying unfavorable trends. In addition -it is in the irrter-est of the worker that the licensee keep accurate dose records and keep copies of pertinent personnel dosimetry processor accreditation certificates with these records. The licensee is required to report certain exposure information to a worker, and a worker may request other reports of occupational exposure that flow directly from the NRC Form 5 records.

b. Practical Utility of the Information Collection The NRC Form 5 data are used by licensees for assessment and control of ongoing programs and as a basis for reports to the NRC (SS 20.1202, 20.1203, 20.1206 and 20.1207) and to the worker (SS 19.13(d), 20.205 and 20.206). The records would also be used by NRC inspectors to determine compliance with the dose-limiting sections of the regulations,

c. Duplication with Other Collections of Information None,

d. Consultations Outside the NRC During the past 36 months, members of the Part 20 revision task force have discussed the proposed revision and sought comments on the various drafts from a number of interested parties. These consultations have included members of the following groups:

--Licensees of various types and sizes Architects, Engineers, Contractors 2 Enclosure 2/ Addendum 4 l-

Power Reactors (LWR)

Research Reactors Universities Uranium Fuel Cycle Facilities Medical Facilities Uranium Mills Well Loggers Radiographers, and others

--Trade Organizations Edison Electric Institute: Health Physics Committees, Subcommittees, and Task Forces American Mining Congress Atomic Industrial Forum, Subcommittee on Occupational Radiation Protection and Conference on Radiation Issues Westinghouse Health Physics Staff (REM Program)

Electric Power Research Institute

--Labor Unions International Brotherhood of Electrical Workers Utility Workers Union of America

--Public Interest Groups Natural Resources Defense Council

--Health Organizations Health Physics Society: National, local Chapters, and ad-hoc Study Groups American Association of Physicists in Medicine Society of Nuclear Medicine National Council on Radiation Protection and Measurements International Commission on Radiological Protection United Nations Scientific Committee on the Effects of Atomic Radiation

--Agreement States Conference of Radiation Control Program Directors 3 Enclosure 2/ Addendum 4

--Federal Agencies and Committees Interagency Working Group on Occupational-Exposure Guidance Environmental Protection Agency Department of Energy Department of Defense Advisory Committee on Reactor Safety and Subcommittees, NRC Occupational Safety and Health Administration Department of Health and Human Services

e. Other Supporting Information

" Cost of Compliance With Occupational Exposure Revisions to 10 CFR Part 20," 12-20-82, developed by S. Cohen & Associates, Inc., under contract with NRC.

3. Description of the Information Collection

a. Number and Type of Respondents Each of the 7,500 NRC specific licensees would be required to keep current occupational radiation exposure records on NRC Form 5, or its equivalent, for each individual worker who enters the licensee's restricted area and.is likely to receive in a year a dose requiring provision of individual monitoring devices or services pursuant to -

5-20.502.

b. Reasonableness of the Schedule for Collecting Information Paragraph 20.1106(d)(2) specifies that entries'of external dose shall be for a period of time not exceeding one calendar quarter,and that estimates of internal dose and the summation of external and internal dose shall be for periods not exceeding one year. These time periods permit evaluation against the time periods specified in the dose-limiting sections and reflect consideration of practical problems that may be associated with assessment of internal doses,

c. Method of Collecting the Information The data to be entered on NRC Form 5, or its equivalent, are the results of monitoring external exposures (film badges, thermo-luminescent dosimeters, etc.) and assessing intake of radioactive 4 Enclosure 2/ Addendum 4

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material (air sampling, urinalysis, fecal analysis, organ counting,

whole body counting, etc.), as required by S 20.502. I 1

d. Record Retention Period l

Paragraph 20.1106(f) specifies that the licensee shall retain the NRC q

Form 5, or equivalent record, and the processor accreditation certif-l icates until the Commission terminates each pertinent license requir-

ing the record. '

1 e. Reporting Period j

This justification does not involve a reporting requirement. Report- ,

ing of personnel monitoring data to the NRC is covered under SS 20.1206 and 20.1207.

I

f. Copies Required to be Submitted The licensee is required to keep one copy of NRC Fo m 5, or equivalen't I

record, for each individual for whom provision of individual monitor- '

ing devices or services is required pursuant to S 20.502.  ;

g.

Format of Information to be Maintained or Submitted The format of the information to be maintained is established by NRC I

, Form 5.

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4

, 4. Estimate of Burden  ;

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a. Estimated Hours Required to Respond to the Collection NRC Form 5 or its equivalent, must be completed by all licensees for all individuals requiring provision of individual monitoring devices or services. It is estimated that 7,500 NRC licensees monitor about  !

3 300,000 individuals per year, that entrica are made on NRC Form 5, i

or equivalent record, month)y, (or whenever they receive the results

} from dosimetry processors) and that each entry requires about 2 minutes (0.033 hour3.819444e-4 days <br />0.00917 hours <br />5.456349e-5 weeks <br />1.25565e-5 months <br />) for a total of about 118.800 hours0.00926 days <br />0.222 hours <br />0.00132 weeks <br />3.044e-4 months <br /> / year (300,000 indi-viduals x 0.033 hour3.819444e-4 days <br />0.00917 hours <br />5.456349e-5 weeks <br />1.25565e-5 months <br /> x 12 entries / year). An additional 5%, or 5,940 hours0.0109 days <br />0.261 hours <br />0.00155 weeks <br />3.5767e-4 months <br />, is estimated for maintaining each required form or record (including preservation of the processor accreditation certificates) for a total of 124,740 hours0.00856 days <br />0.206 hours <br />0.00122 weeks <br />2.8157e-4 months <br /> / year.

5 Enclosure 2/ Addendum 4 -

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1 Number of recordkeepers................... 7,500  !

2 Annual hours per recordkeeper............. 17 3 Total recordkeeping hours................. 124,740  ;

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b. Estimated Cost Required to Respond to the Collection The cost is estimated to be abott $2,500,000/ year (124,740 hours0.00856 days <br />0.206 hours <br />0.00122 weeks <br />2.8157e-4 months <br /> x  :

, $20/ hour).

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1 c. Source of Burden Data and Method for Estimatina the 8urden  !

The burden data and estimates are judgments of NRC staff based on t

experience gained as licensees and as regulators, i l

l d. Reasonableness of Burden Estimates

] The estimates of overall burden are comparable to those developed by  !

S. Cohen & Associates, Inc., under contract with NRC.  :

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i i 5. Estimate of the Cost to the Federal Government l

1 NRC cost is incurred by the inspectors reviewing the information on NRC j Form 5, or equivalent record, maintained by licensees and by the cost of i j printing the NRC Form 5. An average of 2.5 hours5.787037e-5 days <br />0.00139 hours <br />8.267196e-6 weeks <br />1.9025e-6 months <br /> of inspection time per year is spent reviewing the information on NRC Form 5, or equivalent record, '

at each of about 70 reactor sites. An average of 0.5 hour5.787037e-5 days <br />0.00139 hours <br />8.267196e-6 weeks <br />1.9025e-6 months <br /> of inspection i j time per 3 years is spent reviewing such records of about 7,475 materials

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licensees. Therefore, the total inspection time would be about 1,420 hours0.00486 days <br />0.117 hours <br />6.944444e-4 weeks <br />1.5981e-4 months <br /> / -

) year (70 licensees x 2.5 hours5.787037e-5 days <br />0.00139 hours <br />8.267196e-6 weeks <br />1.9025e-6 months <br /> / year + 7,475 licensees x.0.5 hour5.787037e-5 days <br />0.00139 hours <br />8.267196e-6 weeks <br />1.9025e-6 months <br /> /3 years). l l with an associated cost of about $71,000/ year (1,420 hours0.00486 days <br />0.117 hours <br />6.944444e-4 weeks <br />1.5981e-4 months <br /> / year x $50/ hour).

] Cost of printing the forms would be about $15,000/ year. The total cost to

[ the Federal government would be about $86,000/ year.

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! 6 Enclosure 2/ Addendum 4  !

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[7590-01)

APPENDIX H REVISED NRC FORM S CURRENT OCCUPATIONAL RADIATION EXPOSURE Revised NRC Form 5 is appended for the convenience of those who may wish to comment on the proposed regulations. It is not a part of the 4

regulations. However, the Commission does solicit comments on its content.

If the proposed regulations are adopted and codified in Title 10 of the Code of Federal Regulations, the form will be used as a current record of occupational radiation doses for each individual for whom personnel monitoring is required by 5 20.502.

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[7590-01)

INSTRUCTIONS FOR PREPARATION OF NRC FORM 5 The preparation and safekeeping of this form, or a clear and legible record containing all the information required on this form, is required by 6 20.1106 of " Standards for Protection Against Radiation," 10 CFR Part 20, as a current record of occupational radiation doses. Such a record must

'be maintained for each individual for whom personnel monitoring is required by $ 20.502.

Listed below by item are instructions and additional information pertinent to completing this form.

Item 1. Self-explanatory.

Item 2. Self explanatory, except that if an individual has no social security number the word "None" shall be inserted.

i Item 3. Self-explanatory.

Item 4. Self-explanatory.

Item 5. Enter the specific dates that the individual monitoring measure-ment was initiated and terminated. Entries shall be for periods

{ of time not exceeding I calendar quarter. For individuals under continuous monitoring, doses received over a period less than a calendar quarter need not be separately entered on the form provided that the licensee maintains a current record of the dose received by the individual.

Item 6. Enter the external dose equivalent recorded for the lens of the eye. The dose to the lens of the eye is the eye dose equivalent, unless the licensee evaluates the dose to the lens through what-ever shielding is present, or enless the eyes are protected with shields having a tissue equivalent thickness of at least 2

700 mg/cm . When the eyes are protected with shields having at 204 Enclosure 1

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I (7590-01]

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least 700 mg/cm2 the dose to the lens of the eye is the deep '

l dose equivalent. Do not include the dose received during planned I' j special exposures, i  ;

Items 7  !

Enter the external dose equivalent recorded for the skin and I ~ and 8.  !

for the extremities, respectively. The dose to the skin and i the extremities is the shallow dose equivalent, and shall be i 1

averaged over 10 cm2 in the region of the highest exposure.

! Do not include the dose received during planned special exposures. t 4

i 3 Item 9.- Enter the external' deep ' dose equivalent to the whole body. T_he licensee may assess deep dose equivalent through a tissue equiv-  ;

{ alent absorber of 300 mg/cm2 as for eye dose equivalent. Include

{ any dose received as a result of overexposures, accidents, and I emergencies, but do not include doses received during planned j special exposures. 3 i i

Item 10.

! Enter the dose equivalent received during planned special exposures.

Separate entries shall be made for whole body ("WB"),

l 1 ens of the eye (" Eye"), skin (" Skin"), and extremities (" Ext").  :

{ Note that the provisions for planned special exposures do not apply to the intake of radionuclides.

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t j Item 11. Identify the name and lung clearance class of'each radionuclide  ;

j to which the individual has been exposed. If the licensee does t l'

not choose to identify and determine the intake of each indi-vidual radionuclide in a mixture, or if the individual has been exposed to an unknown mixture of radionuclides, enter " Unknown i Mixture." If the exact composition or the respective concentra-

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tions of radionuclides in a mixture is unknown, the licensee '

may treat the total activity taken into the body in terms of that radionuclide having the most limiting ALI and enter " Mixture" 1 and the identity of the controlling raolonuclide.

l 295 Enclosure 1 -

[7590-01)

Item 12.

Enter the best assessment of the amount of each radionuclide, in pCi, taken into the body of the individual during the moni-toring period. If the licensee has used the provisions for mixtures in Item 11, enter the total activity taken into the body.

It may be assumed that exposure to uniform concentrations (DAC) of a radionuclide listed in Appendix 8, 10 CFR Part 20, for 2,000 hours0 days <br />0 hours <br />0 weeks <br />0 months <br /> (40 hours4.62963e-4 days <br />0.0111 hours <br />6.613757e-5 weeks <br />1.522e-5 months <br /> per week for 50 weeks per year, using an inhalation rate of 2x104 al/ minute) will result in an intake equal to the ALI.

Exposure at uniform DAC for fractions of the 2,000 hours0 days <br />0 hours <br />0 weeks <br />0 months <br /> may be assumed to result in proportional fractions of the intake limit. If the provisions of 5 20.205 for control-ling exposures involving radionuclides with very long effective half-lives are used, enter the radionuclide burden in each significantly exposed organ as determined by bioassay. In this case, the calculational techniques, models, and any specific information on the physical and biochemical properties of the radionuclides involved and their behavior in the individual shall be specifically referenced or documented in the exposed individual's record.

Item 13.

Calculate the percentage of the ALI represented by the intake of each radionuclide (Item 12) during the monitoring period and enter the sum of the percentages in Item 13. If one of the

• provisions for mixtures in Item 11 is used, calculate the percentage of the ALI listed for the most limiting radionuclide present in the mixture, or the ALI for Unknown Mixtures, listed in Appendix B, 10 CFR Part 20, as appropriate for the chosen provision.

If the provisions of S 20.205 are used, enter the sum of the percentages of the annual dose limits represented by the weighted annual dose equivalents to each of the significantly exposed organs or tissues.

Item 14 Multiply the percentage value in Item 13 by 5 rems and enter the product in Item 14 This assumes that an intake equivalent to one ALI will result in a committed effective dose eauivalent i

296 Enclosure 1

[7590-01) of 5 rems. If the provisions of 5 20.205 are used, enter both the annual effective dose equivalent and the 50 year committed effective dose equivalent associated with the intake.

1 Item 15. I Enter the sum of the external whole body deep dose equivalent '

(Item 9) and the internal committed effective dose equivalent (Item 14) received by the individual during the current monitor-ing period.

If the provisions of 5 20.205 are used also enter the sum of the external whole body deep dose equivalent and the internal effective dose equivalent.

Item 16.

Add the effective dose equivalent summation (Item 15) for each monitoring period to the previous summation of effective dose equivalent recorded for the year and enter the new summation in Item 16.

Item 17.

Enter that portion of the effective dose equivalent entered in Item,16 that exceeds the 5 rem annual limit.

Item 18.

This space should be used to record any unusual or limiting information suout the data recorded on the form. This could include data on intake of radionuclides prior to (effective date), notation of contribution to dose from multiple employ-ments during a period, dose received by the individual as a patient during medical diagnosis and therapy or dose to the embryo / fetus of a declared pregnant woman.

PRIVACY ACT STATEMENT

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.mC ro,m o ApproT*d by OM3 I

fa c*rb 2e u 1 nucle A3 RCULATORy COMMISSION CURRENT OCCUPATIONAL EXTERNAL RADIATION EXPOSURE See Instructions on Back IDENTIFICATION

1. N AME (PRINT - Last, first, and meddie) 2. SOCIAL SECURITY NO.

3. DATE OF BIRTH (Month, day, yeer) 4. NAME OF LICENSEE

5. DOSE RECORDED FOR (Specify: Whole body; 6. WHOLE 8ODY DOSE 7. METHOD OF MONITORING te.g. him Badge-con of whole body; or hands and forearmA STATUS trem) F 8; Pocket Chamber - PC; Calculations - Calc.)

feet and ankles) X OR GAMMA 8 ETA NEUTRONS

8. PERIOD OF EXPOSURE (From - Tol DOSE FOR THE PE RIOD (rem) 13. RUNNING TOTAL FOR CALENDAR QUARTER

3. X OR GAMMA 10. BETA 11. NEUTRON 12. TOTAL frem) t

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Ltct TIME ACCUMUt ATE O DOSE se pnewmus rotat >== It rotat auAareany se totAt ACCUMutAtED H.Ptmes ACC.0084lestalWeal M **"I to WUSGO Pa At of PtNh4

, AcCUnsutAtse poet hang t

{ INSTRUCTIONS FOR PREPARATlON OF NRC FORM S s j i 1

1 The preparatson and safekeep ng of this form or a clear and legebie items 9, Self emplanatory The values ere to te given m rem.

record conta.nmq att the mformation requwed on this form is re- 10 arx) Att measurements ere to te mterpreted m the twst

) quired purmant to Se<teon 20 401 of Standards for Protecteori i I. method known and m accordance with Parageaph 20 dic)

, Agamst Radeation." 10 CF R 20. as a current record of occupational enternal eadiatoon exposures. Such a record must be memtained Where calculations are made to determine dote, a copy of i ior each mdevidual for whom personnet moneformg is requered such calculations es to be mamtained m coniunction with

(. under Secteon 20.202. Note that a seperate NRC Form 6 rs to be this record in any caw where the dow foe a calendar l used for recordme en ternal emposure to i1) the whose body. nuar ter is less than 10% of the value specified en Parauraph 20101(at the phrsee "les than 10% may tw entered m i (2) skm of wholehody (31 hands and forearms;or (4) feet and heu of a numerecal value.

ankles, as provated by item 6 tw6ow. Item 12. Add the values under items 9.10 and 11 for each period Lasted below by item are instructions and additional information i

oresposure and record the total in calculatmg the 1

directly pertenent to completeng this form. " Total" any entry "sens than 10%" may to desre I ntsfacahon 1 tem 13. The runn.ng totaf es to be maintaened on the bas.parded s of item 1. s;alendar querters. Paravraph 20.3(a) (4) defines calendar 4 tem 2. aesiemplanatory klf emplanatory.encept that, af mdevnkaal has no social Querter. No entry need le made in this item if only caeender quarter redsation doers are recorded m Items 9, q incurity numter, the word "none" shall be innerted. 10,11 and 12.

fMf ',"0j'a"n

, Lifeteme Accumulated Does (whole Sedyl

' Occupenonal E sposure en

,NO T E :,,,,,,,If,,the g n,, , ,,lec,n,s,ee,c,hoo,,ses,

,, ,,,9, pn 79 gog ,t,o,heep gy, t,he indeviduei

! ltem $. **Does to the whole tmdy" shall be deemm1 to enclude any 14 through 18 need not to completed However, m that case 9 i dose to the whole tedy, gonads, actrue blood formmg the total whole body does for each casendar quarter recorded g

l organs, head and trunk, or lens of eye. Unies the lenses m 1 tem 13 f or item 12 it ryuar terty does are entered m f rom l 4

of the eyes are protected with eye sneelds,dow recorded 12) should not onceed 1 1/4 tom.

[

through a e as uter av a at a of If an indivulual 6s eaposed under the erovesions ei Perearsph 20.101 l 300 meicmbor less When the tennes of the eyes are act IDI '0*D U'*' 34 'h'oupi 18 at the end of each calender tsctod with quarter and w' hen the teet es titled. Values m 1 tem 13, when art the of at least Me sheeldt mg hawmg a titsue e@rva6ent thic ness middle of a calenda quarter, and values in item 18, must to beought i i

• • ".'r"Ong;'a'em3, t done recorded as whole body E" Idosen!,'.0'i"#0'

' ' E M s" O "$r'J""fe****"' & ted ase' rom -

l Dow recorded as dow to the skm of the whole body hands done recorde for the indevisuat to g from item t 6 of NHC I and forearms, or feet and anktes thould inctude the done (orm S or item i1 of NRC F orm 4) ihe totaloccupationar i radiation done receeved by the moividual tran st be entered  ;

i ,

i dehvored thicknessthrough a ti3mae of 7 mg/cm equealent or less. abnorter T he dow to thehevmg a s6m of m this item. mc'uom0 any occupational does received I the me icie tudy, hands and forearms, or feet and ankies from sources of radieoon not hcensed by the Commession t' should te verarded on wparate forms unless the done to it the morvidua) was esposed to sources of aadiation not those parts of the body has twen metuded as done to the Aensed by the Commission Wrmg any calender quarter whole t,ody on a form me.ntained for record 4cg whola taorf t af tef compiehng NRC F orm 4 and personnel monitormg  :

ewpment was not worn by me indivuJuat. #t 6nould be '

Item 6, h$s need be completed on8 y when the sheet is used * * 'W'"

to record whole body esposures and the licenwe es r,',', s e <e i e=posmo the endeniduas under the proves.ons of Parearaph item 15.  !

Enter the total calender quer ter done from Itorn 13 (or 20.101tM wh+ch attows up to 3 re ns per querter to the teom item 12 sf querterly dotes are entered 6n item 12) 1

. whole body, Enter m thes elem the unused part of per- and the date desegnatmg the end of *he calentf ar rNarter t 1 messsNe accumulatert does taken frtyn prowsous records of m whsch the does was recetved te g , March 30,19b21.

esposure e e . Item 18 of the preceding NRC F orm S or item item 16. f

!' Add item 14 and item 16 and enter that sum.

i 13 08 NAC f orm 4 if the indrvidual e esposure durmg item 17. Otitain 'he Permns. hse Accumulated Does (PAD) m tem '

-w=6 mth the hcensee begms w'th thes record for the WHOLE 800Y. "N" es eques to the numter of j

4 item 7. Indicate me method used for monitoreg the mdeviduars years nf age of the mdevedual on het test herthdar Sute eract 18 from N and enuit.pty the ditforence by a tem i esposure to each type of radiation to which he es esposed e , John Smim, ove 32, N = 32, PAD = 6(32-18)

• i m the cour w of has eraties Abbreviations may be uwd rem )

item 8. Does received over a period of less than a calender er ter item 18, etermine the unweed pert of the PAD by subtrac tmg g need not he separavety entered on the form prow that item 16 from item 17 The unused part of the PAD I the necenses memtams a current record of the dotes rece=ed 6e that Port *on of the Lefetime Accumulated Does for by the mdiv6 dual wh+ch habe not es yet been entered on the the indevedual remaining et the end of the period i form. The pereod of empomare sh< maid specify me day the covered by this eest. 1 measurement of that esposure was mitteted and the dey -

, on which et was termmeted. $or esamp#e of only quarterty, does are entered the oorlod of esposure for the first ,

casender querter of 1942 m*ght be taken es evnne rom Mondey, January 1,1962, thach,gh F riday, March ( f

( 1M2 t

and w< meld be me cated m this stem as Jan.1, t962 er. 30,,

1962. It wesely doses are entere4, a film bedge tenyed . ,

! Monday morneng. January 1,1962, and picked up e ridey

! January 6,1962, would be mdecated as Jen.1,1982 Jan, b, l 1962.

PalVACY ACI $f AllMihi

! Parsi. eat to 5 U $ C 557 ele) f 3), enetted ete law t, seti e 3 of the Pr n, Ace of 19 74 IPuni.e L se t3 liti the fesio .ag stetemeat is fwea4hed to .ad vidueli who 1 s .ma m,e < ea, w ,C,.-s-ea .mc f e,.a i n.s -ev e m emed . . s,seecer.s .es,e,ed es .re w e,,,,se.e4 -

l st 40 f edevel Rev s'n 4134410ctober 1.191%I e I AufM0mifY 1.tt.eas l3. 63,65,8 8,103.104,16 t(bl. end 16 tlel of the Atom 4 f aegv At t t.f 1960 es e**aded (47 U S C 70f 3. 7013 701). 7 8 tl. 7133, l Pl34. 770 t160 ead ??0f den the author tv for sehe.t.q Ihe te<>st tetures, avetier es 10 C f M Pet 70 {

• t 7 PRINCIPAL PURPOSI(11 1he meeemehen e wied 6, she fliRC .a ets eveivet ea of the ene of #3d.shca esPetsie ettebMed mth the 3. teased ettely ead m l

! e.e.t., t. ter vor, te,,e . ... .e men.ter end re,se,e tw set.t. so bee. ,et t< es of .t.se-s Ih. do. ,-... e mesa.,,f.. t e,er.,sa of .eth ti.e ,

re.,e e< ,ea, ,* m es,.e..re es,.r. ace eme, te,. of weasee, ead eme, h. ea.e, m,b ..h f.,. 0,. o ,o , e e, re te ,.d ..en ,, e . te , .,,oa

.i ,e.,, reque . ,

?

3 ROUflNt U51; Ihe saforme.ea stiev ube sed to snevide case re other ieenet ead State event et measved a meaaeses ead er eveiushat end'eteen esensf I

! en e.ved be ed+4wa's empleved et sed st.ea eertert en a pe#maa**t er semposes, besit sad e sevenue e tere +ved h, monitosed v+ tore ihe setmmstion me, erte be l

! dwaied to ea .nve.aice iedeep sive. , sa, e.rac, .a the e,*ai che .af eme.e maa c.i . ..m.hin ne vetenhe ..eie.e. et es. ew m the t e.ais of en t [

.d oaar o.ee w p,da.4 or.**d,a, t

l 4 6Hif MIR DISCt05Umf 15 UANDAf 081Y OR VOLU4f ARY A9U f f fICf 04 INulVIDVAL Of 40f PROV Di4G 1470RWAfl04 I

f t a venates theev oar <4a se.eg,esw etarms.am eciuo.g sex e swvH,au mter 'e ore me tceasee mu st ce%,.,halC 8 cem ien ese verae tot e'va L j pestonne6 meartgring .g requeed under to Cf M 70 707 f e.tuee te de te me, tutiinit the tetrasee to ea8ertemeat sit.on a streedvire mite IO Cf A 70 601

} Theser.eiset .tr awebee es +,ied to ensure that NRC be sie neueste . dent.8er met s.,tett to tre to.araime et i.m.ie acaet v hiethdetes cae q p. Ice p e a. mbe of .= seas sa .aem d.e .: m.. ate d '

j t sysiiu uA4At.f at$1 ANO A00 Ai$$ ormer oaite ense%geawas and 8.rgem Me ru u a ev,e, a., wry,Candoen m sh.n , .e c ;o m

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