ML20206F962

Request for OMB Review & Supporting Statement Re Rept of Proposed Activities in non-Agreement States,Areas of Exclusive Federal Jurisdiction,Or Offshore Waters.Estimated Respondent Burden 1,200 Hours

ML20206F962
Person / Time
Issue date:	05/04/1999
From:	Shelton B NRC
To:
Shared Package
ML20206F960	List: ML20206F958 ML20206F962
References
OMB-3150-0013, OMB-3150-13, NUDOCS 9905070023
Download: ML20206F962 (10)

Text

WNN D M86M4c' PAPERWORK REDUCTION ACT SUBM!SSION

• Pa/a

Please read the instruchons before ~----- ' 3 vour agency's Paperw:rk Cle:rance Effic;r.g th:s form. For additional forms or assist,nce in completing this form, contact S:nd two copies cf this form tha c:ll:ction instrument to be ravi:wid, ths Supporting Stat; ment and cny cdditirnal docum:ntati:n to: Offico cf inbrmatirn cnd Regulittry Affaire, Offic3 cf

. Manag6 ment and Builget Docket Library, Room 10102,72617th Street NW, Washington, DC 20603.

3

1. Nws / Subagency ongmahng request

2. OM8 control number r

U.S. Nuclear Regalatory Commisslos g

a.

3150- 0013 b.None

3. Type of informebon collecbon (check one) 3 Type of revow requested (check one)

a. New collection y

a. Regular

c. Delegated

b. Revision of a currently approved collection

b. Emergency. Approval requested by (date):

-g c. Extension of a currently approved coNection

5. Will this informaHon collection have s a.Yes agftcent economic impact on a s

d. Re g of lously approved tantial number of sman entities?

b.No

e. Re eme" for ob s e V

a. Three years from approval date red Wehd

f. Existing conection in use without an OMB control number ewsbon date

b. Other (Specify)-

7. Title Report of Proposed Activities in Non Agreement States, Areas of Exclusive Federal Jurisdiction, or Offshore Waters

8. Agency form number (s) (if app 4cabie)

NRC Form 241

g. Keywords Radioactive Materisis, radiaction safeety

10. Abstract Under the reciprocity provisions of 10 CFR Part 150, any Agreement State licensee who engages in activities of radioactive byproduct material) in Non-Aareement States, areas of exclusive Federal jurisdiction, or offsho(use re waters, under the general license In Section 150.20 is required to file an NRC Form 241 at least 3 days before engaging in each such activity,ities are being conducted in accordance with requirements for protect to determine whether the activ public health and safety.

11. Aflected pubiec pas,e penery me w ow as ame a mer awy m M

12. Obligation to respond (aawe,,mery me e ear e omes mar amwy me n

~

a. Individuals or households d.Farme

a. Voluntary T

b. Business or other for-profit

e. Federal Govemment

b. Required to obtain or retain benefits

~

c. Not for-profit institutions T

f. State. Local or Tnbal GovemmentT c. Mandatory

13. Annual reporting and recordkeepmg hour burden

14. Annual reporting and recordkeeping cost burden im mouseme orcusws)

a. Number of respondents 200

a. Mal annusued capaavstartup eats

b. Totalannualresponses 4,600

b. Total annual costs (O&M)

1. Percentage of these responses

c. Total annualized cost requested conected electromceNy 0.0

d. current oms inventory

c. Total annual hours requested 1.200

e. o,,,e,ence

d. Current OMS inventory 1,200

f. Explanation of difference

e. D,fferencs 0

f. Explanation of differencs

8'** ***"9'

1. Program change

2. Adjustment

2. Adjustment

15. Purpose of snformation collection

16. Frequency of recordkeepmg or reporting (chec* sa met appfy)

(Adors armory e 7 anct as omers met appfy e M

a. Recordkeeping

b. Third-party disclosure

]

a. Application for benefits

] e. Program planning or management ] ]c. Reportmg

b. Program evaluation

f. Research

1. On occasion

2. Weekly

3. Monthly

~

c, General purpose statistics T

g. Regulatory or complance

4. Quarterly

5. Semi-annually

6. Annually

~

d. Audit

7. Biennially

8. Other (describe) 17,3tatstical methode

18. Agency contact (person who can best answer guescons reperces me Does this information coNoction employ statistical methods?

Name:

Frank P. Cardile Yes

% No Phone:

301-415-6185 l

Olet 834 The nm en e u.ms warme 10/95

~

9905070023 990504 PDR ORG EUSOMB PDR

L

19. Certification for Paperwork Reduction Act Submissions On behalf of this Federal agency, I certify that the collection ofinformation encompassed by this request complies with j

5 CFR 1320.9.

NOTE: ne text of 5 CFR 1320.9, and the related provisions of 5 CFR 1320.8 (b)(3), appear at the end of the 1

instructions. The certification is to be mada with reference to those regulatoryprovisions as setforth in the instructions.

1 ne following is a summary of the topics, regarding the proposed collection ofinformation, that the certification covers:

(a) It is necessary for the proper performance of agency functions; (b) It avoids unnecessary duplication; (c) It reduces burden on small entities; (d) It uses plain, coheren', and unambiguous terminology that is understandable to respondents; t

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices; (f) It indicates the retention periods for recordkeeping requirements; (g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3):

(i)

Why the information is being collected; I

(ii) Use ofinformation; (iii) Burden estimate; (iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature of extent of confidentiality; and (vi) Need to display currently valid OMB control number; (h) It was developed by an office that has planned and allocated resources for the efficient and effec'ive management and use of the information to be collected (see note in item 19 of the instructions);

(i) It uses effective and efficient statistical survey methodology; and f

(j) It makes appropriate use ofinformation technology.

If you are unable to certify compliance with any of these provisions, identify the item below and explain the reason in Item 18 of the Supporting S:atement.

Date Sgnature of Authonzed Agency Ofnoel Date Signature of Sena Omcsal or des'

/

hs.A f

- a Iton C

r, of the CNef Information OfRcer M

l 10/95 oms 831 l

l l

=

- 1'

' FINAL OMB SUPPORTING STATEMENT FOR NRC FORM 241 REPORT OF PROPOSED ACTIVITIES IN NON AGREEMENT STATES, AREAS OF EXCLUSIVE FEDERAL JURISDICTION, OR OFFSHORE WATERS (3150-0013)

EXTENSION REQUEST Description of the information Collection Section 274 of the Atomic Energy Act of 1954, as amended, authorizes the Nuclear Regulatory Commission to enter into an agreement with the Govemor of any State providing for discontinuance of certain regulatory authority of the Commission. A State that has signed such an agreement with the NRC allowing the State to regulate the use of radioactive material within that State is referred to as an Agreement State. Under NRC's regulations in 10 CFR Part 150,

" Exemptions and Continued Regulatory Authority in Agreement States and in Offshore Waters Under Section 274," the NRC refrains from exercising certain licensing authority in Agreement States and exempts persons in those States from certain NRC licensing requirements. The name of the form has been changed from " Report of Proposed Activities in Non-Agreement States' to include areas of exclusive Federal jurisdicticn or offshore waters. This change more accurately reflects the scope of licensees already required to use this form under reciprocity and does not expand the universe of respondents nor does it result in any change to the burden estimate.

Under the reciprocity provisions of 10 CFR Part 150, any Agreement State licensee who engages in activities (use of radioactive byproduct material)in non-Agreement States, areas of exclusive Federal jurisdiction, or offshore waters under the general license in Section 150.20 is required to file with the NRC 4 copies of NRC Form 241 and 4 copies of its Agreement State license at least 3 days before engaging in each such activity. The 3 day time schedule permits the NRC regional office time to schedule inspections of these activities.

A.

JUSTIFICATION

' 1.

Need for and Practical Utility of the Collection of Information Section 150.20 establishes a generallicense whereby NRC authorizes any person who holds a specific license from an Agreement State to conduct the same activity in non-Agreement States, areas of exclusive Federal jurisdiction, or offshore waters for a period not to exceed 180 days in any calendar year. Any Agreement State licensee who engages in activities under the general license in Section 150.20 is required to file with the NRC regional office 4 copies of NRC Form 241 and 4 copies of its Agreement State license at least 3 days before engaging in each such activity. The regional administrator of the NRC regional office may authorize an Agreement State licensee to commence activity upon notification by telephone of intent to conduct the proposed activity under the generallicense, provided that NRC Form 241 is filed within 3 days after the telephone notification. The regional administrator may also waive the

7 requirim:nts for filing addition:l copus of NRC Form 241 during tha rsmiinder of t

l 1

the calender year following the receipt of the initial NRC Form 241 from a person l.

engaging in activities under the general license, l

l Receipt of the information on NRC Form 241 is necessary to make NRC aware of Agreement State licensees' activities in non-Agreement States, areas of exclusive Federaljurisdiction, or offshore waters so that NRC can determine.

whether the activities are conducted in accordance with NRC requirements for i

protection of the public health and safety.

2.

Aaency Use of the Information The report informs NRC of the locations and dates of activities conducted in non-Agreement States, areas of exclusive Federal jurisdiction, or offshore waters by Agreement State licensees under the general license in 10 CFR 150.20. This i

notification permits the NRC regional office to schedule inspections of the activities to determine whether the activities are conducted in accordance with NRC requirements for protection of the public health and safety.

3.

Reduction of Burden Throuah Information Technoloov l

There are no legal obstacles to reducing the burden through information technology. The NRC encourages applicants and licensees to use new automated information technology when it is beneficial to them. However, NRC Form 241 does not lend itself readily to the use of automated information technology for submission because of the limited information required and the l

infrequency of submission.. Consequently, the current percentage of electronic 4

submissions is zero.

i 4.

Effort to identify Duolication and Use Similar Information The information Requirements Control Automated System (IRCAS) was searched to determine duplication. None was found.

The Agreement State licensees do not routinely submit information to the NRC.

I Therefore, there is no similar information available to NRC that can be used to keep track of the Agreement State licensees' activities conducted in j

non-Agreement States, areas of exclusive Federal jurisdiction, or offshore waters under the general license provided for in 10 CFR 150.20.

5.

Effort to Reduce Small Business Burden i

Some of the Agreement State licensees who use byproduct material in non-Agreement States, areas of exclusive Federal jurisdiction, or offshore waters are small businesses. However, because the health and safety consequences'of improper handling or use of byproduct material are the same for large and small entities, it is not possible to reduce the burden on small businesses by less frequent or less complete reporting. In addition, the burden of the notification is slight.

+

- ~.. - - -

. ~,.,

..~~4

a

~

l 6.

Consecuences to Federal Proaram or Policy Activities if the Collection is Not

~

i. V Conducted or is Conducted Less Freauentiv If the information on NRC Form 241 is not collected, the NRC will not be aware of i

Agreement State licensees' activities involving byproduct material in non-Agreement States, areas of exclusive Federal jurisdiction, or offshore waters.

The forms are submitted only as the specified uses occur. NRC Form 241 must be submitted prior to each such activity, but the NRC regional office may waive the requirement for filing additional forms during the remainder of the calendar year following the receipt of the initial NRC Form 241 from the Agreement State l

licensee.

7.

Circumstances Which Justifv Variation from OMB Guidelines Contrary to the Office of Management and Budget guidelines in 5 CFR 1320.5(d),

Section 150.20 requires that 4 copies of NRC Form 241 and the Agreement State specific license be filed with the NRC regional administrator for the region in which the Agreement State that issues the specific license is located. The NRC regional office retains one copy of each, and sends one copy to the Agreement State that issued the specific license, one copy to the State in which the activities are to be conducted, and one copy to the NRC regional office in which this latter State is located. These copies are needed so that those offices can all be made aware of the activities in their jurisdictions and the activities authorized by the i

Agreement State license, and so that the NRC regional office can schedule

)

inspections of these activities.

8.

Consultations Outside the NRC 1

An opportunity to comment on the information collection requirements for this clearance extension was published in the Federal Reaister on February 2,1999 (64 FR 5077). There were no comments, j

l 9.

Payment or Gift to Resoondents j

Not applicable.

10.

Confidentiality of the Information None. The information submitted to NRC on Form 241 is available to the public.

I 11.

Justification for Sensitive Questions This information collection does not involve sensitive questions.

12.

Estimated Burden and Burden Hour Cost Based on historical data, it is expected that approximately 200 initial submissions of NRC Form 241,1100 revisions to NRC Form 241, and 3300 clarifications of the information submitted on NRC Form 241 will be filed annually. It is estimated 1

et

that the an'nual burden on an Agreement State licensee is' 30 minutes per initial 2

completion of NRC Form 241, or an annual industry burden of 100 hours0.00116 days <br />0.0278 hours <br />1.653439e-4 weeks <br />3.805e-5 months <br /> (200 responses / year X 0.5 hours5.787037e-5 days <br />0.00139 hours <br />8.267196e-6 weeks <br />1.9025e-6 months <br /> / response); 15 minutes per revision, or an annual industry burden of 275 hours0.00318 days <br />0.0764 hours <br />4.546958e-4 weeks <br />1.046375e-4 months <br /> (1100 revisions / year x 0.25 hours2.893519e-4 days <br />0.00694 hours <br />4.133598e-5 weeks <br />9.5125e-6 months <br /> / revision); and 15 minutes per clarification, or an annualindustry burden of 325 hours0.00376 days <br />0.0903 hours <br />5.373677e-4 weeks <br />1.236625e-4 months <br /> (3300 clarifications / year x 0.25 hours2.893519e-4 days <br />0.00694 hours <br />4.133598e-5 weeks <br />9.5125e-6 months <br /> / clarification). The estimated total burden would be 1200 hours0.0139 days <br />0.333 hours <br />0.00198 weeks <br />4.566e-4 months <br /> / year and the total burden hour cost would be $145,200, based on NRC's fully recoverable fee rate of $121/ hour for professional staff.

13.

Estimate of Other Additional Costs None.

14.

Estimated Annualized Cost to the Federal Government it is estimateo itat the annual cost to the govemment for the review, acknowledgmen':, deficiency requests, and further dissemination of each NRC Form 241 is about 2.5 hours5.787037e-5 days <br />0.00139 hours <br />8.267196e-6 weeks <br />1.9025e-6 months <br /> annually for nach of the 200 initial reciprocity requests, for a cost of $60,500 (500 hours0.00579 days <br />0.139 hours <br />8.267196e-4 weeks <br />1.9025e-4 months <br /> x $121/hr); 1 hour1.157407e-5 days <br />2.777778e-4 hours <br />1.653439e-6 weeks <br />3.805e-7 months <br /> / response for each of the 1100 revisions, for a cost of !133,100 (1100 hours0.0127 days <br />0.306 hours <br />0.00182 weeks <br />4.1855e-4 months <br /> x $121/hr); and 15 minutes / response for each of the 3300 clarifications, for a cost of $99,825 (825 hours0.00955 days <br />0.229 hours <br />0.00136 weeks <br />3.139125e-4 months <br /> x $121/hr). Therefore, the total estimated annualized cost to the Federal government is 2425 hours0.0281 days <br />0.674 hours <br />0.00401 weeks <br />9.227125e-4 months <br /> or $293,425 (2425 hours0.0281 days <br />0.674 hours <br />0.00401 weeks <br />9.227125e-4 months <br /> / year x $121/hr). This cost is fully recovered through license fees charged to NRC licensees pursuant to 10 CFR Parts 170 and/or 171.

15.

Reasons for Chances in Burden or Cost There is no change in burden. There is a small increase in costs to reflect the difference in the professional staff hourly rate.

16.

Publication for Statistical Use This information will not be published for statistical use.

17.

Eqjson for Not Disolavino the Exoiration Date The expiration date is displayed on NRC Form 241.

18.

Exceptions to the Certification Statement There are no exceptions.

B.

COLLECTIONS OF INFORMATION EMPLOYING STATISTICAL METHODS Not applicab'e.

e

_m

.i IstC FORM 341 APPROVED BY OMB: NO.31500013 (hW YYYY)

EXPIRES: MM/DD/YYYY U.S.NUCl2AR REGULATORY COMMISSION 9

REPORT OF PROPOSED ACTMTIES IN NON AGREEMENT STATES, AREAS OF EXCLUSNE i EDERAL JURISDICTION, OR OFFSHORE WATERS PLEASE READ THIS INFORMATION AND THESEWSTRUCTIONS BEFORE COMPLETING NRC FORM 241 Section 150.20 of 10 CFR 150 establisha) a general iconse authorizing any person who holds a specinc Econse from en " Agreement State"(a State with which the U.S. Nuclear Regulatory Commission has entered into an effec 6ve agreement under subsection 274b of the Atomic Energy Act of ig54) where the Econsee maintains an ORice for directng the Econsed ac6vity and at which radiabon safety records are normaBy maintained, to conduct the same actMty in Non-Agreement States, areas of exclusive Federal jurisection, or in ofIthore waters if the specine Econee issued by the Agreement State does not imit the authorized actMty to specified locatmns or instalatons.

INSTRUCTIONS Ucensees. cannot perform work in areas of exclusive Federaljuriedebon without either (a) fliing NRC Form 241 for reciprocity in accordance with 10 CFR 150.20(b) or (b) applying for a specinc NRC license. An area of exclusive Federaljuriedebon is an area over which the Federal govemment exercises legal control without interference from the jurisdic6on and administration of State law. For example: If the work is to be performed on Federal property in an Agreement State, the Econsee must Rrst determine the juriedebonal status of the area where the licensee plans to work, if the jurisdctional status of the work site is unknown to the Econsee, the Agreement State licensee should contact the Federal 6gency that controls the facihty where the work is to be performed. A written statement concoming the jurisdic6onal status is not required in ords: to flie for reciprocity; however, it is recommended that the Agreement State licensee obtain such a statement for the file for future reference and inspection purposes.

For licensees seeking to conduct actMties under reciprocity for the Rrst time in a calendar year, submit this Form,4 copies of the Agreement State speciRc Econes and the fee specified in fee Category 16,10 CFR 170.31. NRC rnust receive this filing at least 3 odys before the Econsee engages in actMbes permitted under the General Ucense established by Section 150.20 of 10 CFR 150.

In general, the preferred method of filing is through the transmission by facsimile of NRC Form 241, the Agreement State Beenee, and a ccpy of the check as this method avoids many 6 ming problems which may be caused by use of the mal. If the facsimas method is used, the transmission must be received by NRC 3 days before the Econsee engages in the actMty and contains a copy of the check that wil be mailed to meet fee requirements. In addition, for inrtial filings, the Econsee must also file the four copies of NRC Form 241, four copies of the Agreement State license, and the check for the fee within 3 dan of facsimile trarismission. Altematively, the Econsee may flie the rsquired information through the mail ^r other means as long as NRC receives the informa6cn at least 3 days before k licensee engages in the actMty in compleung NRC Form 241, it is important that the !nformation submitted on NRC Form 241 be speciRc regarding the loca6on and date of use as wel as the actMty requested. If it is not possible to provide complete information, such as addresses for the locations of work, the Econsee should provide as much informa6on as possible. The licensee is responsible for providing additionalinformation as revisions cr clarifications se soon as such information becomes available.

ARfD1 Fcr Econsees seeking to conduct actMties under reciprocity for the first time in a calender year, submit this Form,4 copies of the Agreerr.ent State specific Neense and the fee speclRed in fee Category 16,10 CFR 170.31. NRC must receive this filing at least 3 days before the licensee engages in actM6es permlO d under the General Ucense established by Section 150.20 of 10 CFR 150. The Econsee should check the "initiaf' box if this is th e Rrst submission of Form 241 for the year.

Fcr revisions such as addrbonal work iocatiom, changea to the radioactive material, or work actMbes that are different from the information submitted on the initial NRC Form 241, Ece'oes should file by NRC Form 241 or letter, with the appropriate fee so that NRC receives the filing at least 3 days prior to engaging in such actMty Ucensels should check the " revision" box to indcate revisions to the inibal NRC Form 241. It is not necessary to resubmit the Agreement State iconse untees the license has been amended since the flhng of the initial NRC Form 241.

Providing the regional ofhve with informa6on that clan,$es or deletes specifk locations or work sites; chan work site contacts; or adds cr deletes dates of work different from the initial NRC Form 241 is considerqd a clarthcabon and not a r

. The licensee should check "clanRcaNoe b indicate that the changes are only ciertneations to the inforn ation provided on the initial NRC Form 241. Itis not necessary u : Aubmk the Agreement State Scense unless the license has t een amended since the flung of the initial NRC Form 241 No fee is required for ciertncc6cne NRC Form 241 may be used for submitting multiple work locahons and clie1s for initial fliings of NRC form 241, as wel as for submitting revisions and clartRea6ons to previous fuings. Separate sheets may be usec provkler it includes al of the requested informa6on in items 916 of NRC Form 241.

Under the general Econse, reciprocity actMties are authorized only se long a a the licensee hok, a vald radioac6ve materiallicense. If the license expires during the year, an extension letter or a renewed licenu isse ed by the regulating agency must be subjitted to NRC before performing any additional work under reciprocity, items 12. - 16.

Under the general Econse, reciprocity actM6es, including storage (usage), conducted in non-Agreement States erd areas of exclusive Federaljunsdic6on, are limited to a total of 160 days in any calendar year ennpt for work conducted in off-shore waters, which is authorized for en unlimited period of tlme in a calendar year. NRC tracks re :iprocity usage on the basis of approved usage days. NRC wil not approve any actMty under the general Econee which causes the total usage days to exceed 180 days, except for work conducted in off-shore waters. NRC may note and notify the licensee that a fling proposes reciprocity actMties which approach or would exceed the 180-day imit. It is important that Econsees track the days of use and clartfy ( r delete dates of work when applicable

Item 12. ehould reference the proposed beginning and endng dates of work for each work loce6on with th3 total number cf days worked recorded in item 13. Item 14. should be completed to show addibond work dates different from those provided cn the initial NRC Ferm 241 and item 15. should indeste dates when work was not performed, as inillegy requested, that need to be deleted fr:m th) total work days. The Loce6on Reference Number in item 16. is generated by the NRC for use in tracking reciprodty actMbes and is specMc for *

- each work loce6on The Location Reference Number should be referenced for any revisions or clarmestone to work loce6on informa6on.

JhlILit Uceneses should iden6fy the specac make and model numbers of eseled sources and devices.

NOTE: Inspec6ons by NRC of actMiles performed in non-A0reement States, areas of exclusive Federaljurindebon, or offshore waters by soment State iconsees opers6ng under the generallicense in 10 CFR 150.20 may be conducted at the hated work site i

or at the iconsee's home office address. Falure to fue an NRC Form 241 may result in cMi or criminal penal 6es.

J four copies of the Agreement State A0reement State Econsees seelong to conduct actMties under Reciprocity should file this Form'strstor Hoted below for the licones, and the appropriate fee with the U.S. Nuclear Regulatory Commission Regional Admiru j

the Agreement State that leeued the specMc iconee is located:

IF THE AGREEMENT STATE LICENSE 18 ISSUED BY:

IF THE AGREEMENT STATE LICENSE IS ISSUED BY:

Maine, Maryland, Massachusetts, New Hampshire, Alabama, Florida, Georgia, Kentucky, Mississippi, North l

New York, or Rhode Island, Carolina, South Carolina, or Tennessee, SEND APPLICATION AND FEE PAYMNT 70:

SEND APPLICATION AND FEE PAYMENT TO:

Regional Administrator Reglenal Administrator l

Division of Nuclear Material Safety Division of Nuclear Material Safety A1TN: Reciprocity Request ATTN: Reciprocity Request Nuclear Materials Safety Branch U.S. Nuclear Regulatory Commission, Region N U.S. Nuclear Regu;atory Commission, Region i Sam Nunn Atlanta Federal Center l

475 A!lendale Road 61 Forsyth Street, S.W., Suite 23T85 King of Prussia, PA 19406 1415 Atlanta, GA 30303 4931 Tclephone Number (800)4321156 Telephone Number (800) 5774510 i

Facsimile Number (610) 337 8393 Facsimile Number (404) 562 4g55 IF THE AGREEMENT STATE LICENSE IS ISSUED bf:

IF THE AGREEMENT STATE LICENSE IS ISSUED BY:

lilinois, or lows, Arizona, Arkansas, Califonila, Colorado, Idaho, Kansas, Louisiana, Nebraska, Nevada, New Mexico, North Dakota, SEND APPLICATION AND FEE PAYMENT TO:

Oregon, Texas, Utah, or Washington, l

Regional Administrator SEND APPLICATION AND FEE PAYMENT TO:

l Division of Nuclear Material Safety ATTN: Reciprocity Request Regional Administrator U.S. Nuclear Regulatory Commission, Region M Division of Nuclear Material Safety 801 Warrenville Road ATTN: Reciprocity Request Lisle,IL 60532 4351 U.S. Nuclear Regulatory Commission, Region IV Tclephone Number (630) 8294887 811 Ryan Plaza Drive, Sul5 400 l

Facsimile Number (630) 515-1250 Arlington, TX 76011 4 064 l

Telephone Number (817) 8604100 l

Facsimile Number (817) 8604263 150.20 Recognition of Agreement State 'Jcensees (a)(1) Provided that the provisions of paragraph (b) of this socilon have been met, any person who hol6 a specMc license from en l

l Agreement State, where the Econsee maintains an ofGce for drecting the Econsed actMty and retainirr f.edis6on safety records, is granted a generallicense to conduct the same actMty in (!) Non-A0reement States; (i) Areas of exclusive Federaljuriodenon with5 Agreement States; and (iii) Offshore waters.

(2) The provisions of paragraph (a)(1) of this sec6on do not apply F the specific A0reement State Econee imits the authorized actMty to a specific instalaton or locanon (b) Notwithstandng any provision to the contrary in any specific Econse issued by an A0reement State to a person engaging in actMues in a non-Agreement State, in an area of exdusive Federal jurisdc6on within an Agreement State, or in offshore waters under the general Icenses provided in this secton, the generallicenses provided in this secton are subject to al the provisions of the Act, now or hereafter in effect, and to aR applicable rules, regula6ons, and orders of the Commission includng the provisions of $$30.7 (a) through (f),

30.9,30.10,30.14(d),30.34,30.41, and 30.51 to 30.63,inducive, of part 30 of this chapter; 5940.7 (a)through (f),40.9,40.10,40.41, 40.51,40.61,40.63 inck:sive,40.71 and 40.81 of part 40 of this chapter; $$70.7 (a) through (f),70.9,70.10,70.32,70.42,70.61 to 70.56, indusive,70.60 to 70.62,indusive, and to the provisions of 10 CFR parts 19,20 and 71 and subpart B of part 34, $$39.15 and 39.31 through 39.77, induelve, of part 39 of this chapter. In addition, any pctson engaging in actMties in non-Agreement States, in aroes of exduelve Federaljurisdic6on within Agreement States, or in offshore waters under the generallicenses provided in this sec6on:

,_4-g

r (1) Emospt es speciRed In peregraph (c) of this section, ehes, ct least 3 days before enoegos in each actMty for the IIret time in a celander year, file s submatal containing an NRC Form 241,

• Report of Proposed ActMties in Non Agreement Statesereas of Federal juriedelion or off shore waters? 4 copies of Cs Agreement State specific license, and the appropriate fee es prescribed in $170.31 of this chapter with the Cogional Administrator of the U.S. Nucieer ReOulatory Comnimelon Regional OfRce listed on the NRC Form 241 and in Appendec D of Part 20 of this chapter for the Region in which the Agreement d

State met issued the Econes is le=*ar'. If a submittel cannot be filed 3 days before enge0in0 in actMties under reciprocity, tueuse of an emergency or other reeman, me Regional.Winistrator may wolve the 3< ley time requirement provided the licensee: (I) Informs the Region by telephone, feceimus, en NRC Form 241, or a letter of inihel actMties or revleions to the informehon submitted on the initial NRC Form 241; (ii) Receives oral or written authortzetion for the actMty from the Region; and (Ili) Within 3 days after the notdicaten, flies an NRC Form 241,4 copies of the A reement State license, and the fee payment.

0 (2) 6;,.? *% en amended NRC F4/m 241 or letter and the appropriate fee as prescritsad in $170.31 of this chapter with the Regional Admirustrati r to request approval for changes in work loca6ons, radioactive material, or work actMbes different from the informa6on containe e on the initial NRC Form 241.

(3) Shad not, in any non-Agreement State, in an area of exclusive Federaljurisdicbon within an Agreement State, or in offshore waters, transfer or dispose of radioactve material possessed or used under the general licenses provided in this section, except by transfer to a person who is (I) SpecrHeally Econsed by the Commission to receive this material; or (ii) Exempt from the requirements for a Econse for material under $30.14 of this chapter.

(4) Shal not, under the generallicense concoming actMbes in non-Agreement States or in areas of exclusive Federal jurisdiction within Agreement States, poeraes or use radioeceve materiais, or er' gage in the actMties authorized in paragraph (a) of this section, for more than 180 days in any calender year, except that the general Econse in paragraph (a) of this section concoming actMbes in offshore waters authorizes that person to possess or use radioactive materials, or engage in the actMbes authorized, for an unimited period of time.

(5) Shel comply with all terms and condition's of the specific iconse issued by an Agreement State except such terms or conditions as are contrary to the requirements of this section.

(c) A person engaging in actmbes in offshore waters under the generalicense provided for that purpose in paragraph (a) of this sec6on need not file a Form NRC - 241 (revised) with the Commission under paragraph (b)(1) of tNs section, provided, that (1) At least 3 days before engaging in each such activity the person notifies the Agreement State that issued the specific icones about the actMty, including in the notfication (i) e descripton of the actMty, (ii) the location, (iii) the dates scheduled, (iv) a list of the sealed sources, or devices containing sealed sources, which wiR be possessed, used, instaued, serviced, or tested, and (v) a description of ths type and quantity of radioactive material contained in each sealed source or device; and (2) The Agreement State that issued the specinc Econse is listed in paragraph (d) of this section as having entered into an agreement to perform inspections and other functions for the Commission.

(d) The fotowing Agreement State has entered into an agreement to perform inspecbons and other functions for the Commission:

L:uisiana.

[35 FR 7725, May 20,1970, as amended at 38 FR 1273, Jan.11,1973; d6 FR 44152, Sept 3,1981; 46 FR 50781, Oct 15,1981: 52 FR 41700, Oct 30,1987; 55 FR 10406, Mar. 21,1990; 56 FR 54779, Oct 23,1991; 58 FR 52414, Oct 8,1993; 62 FR 1665, Jan.13, 1997; 62 FR 28973, May 281997)

/

s

I NRC FORM 241 U.S. NUCLEAR R.EQULATORY COMMIS$40N APPROVED BY OMS: NO. 316H013 EXPlRES: MMIDtXYYYY pyg Eehmeted burden per response to comply with this mandstory ocdledian requ st: 15 minuies. This notrficttion le reguired so thrt NHC may e

achedu6e inspection of the octarlhas to ensuri mas they are conduded in l

accordance weh require M'v. 5ead reramea'.ments for pr 2

REPORT OF PROPOSED ACTIVITIES IN are

<dia burdea =timei ioine a+ cord (hgh,g$dehYaW NON-AGREEMENT STATES, AREAS OF EXCLUSIVE t

o,

• ' "fio',', J"r*"'. "do'n"nM FEDERAL JURISDICTION, OR OFFSHORE WATERS

1. se3l#o,o2d'Sid "h n"$*is u 2

d conection does nol dyisy a currency vend ous contros number, sie Pease reed the InstructlOns before completing this krm)

NRQ*{ "l, RL*j* *,_ ***

• P*** ** *** '****'** '*

1. NAME OF UCENSEE ph. cr firrn poposang b eenduct me ecovese ameansed assow)

2. TYPE OF REPORT INITIAL REVISION O CLARIFICATION l

S. ADORES 8 OF UCENSEE (Meang etwees oramor:

. wAsse kenene mey as moodsic 4 UCENSEECOVTACT ANDTTTLE I

6.

NUMBER

6. F CSIMIL

7. ACTNITIES TO BE CONDUCTED UNDER THE GENERAL LICENSE GNEN IN 10 CFR 150.20 I

WELL LOGGING LEAK TESTING AND/OR CALIBRATIONS TELETHERAPY /lRRADIATOR SERVICE PORTABLE GAUGES OTHER (Specify) 4 REGarrERED A8 USER OF PACKAGING (CERTIFICATES OF COMPUANCE NUMBERS)

RADIOGRAPHY 4

e. CUENT NAME. ADDRESS, CITYJCOVNTY, STATE, ZIP CODE 9A PHYSC SS OF gLOCATION

10. CLIE TELE NUMBER

11. W L

TION TELEPHONE NUMBER

12. DATES SCHEDULED

13. NUMBER OF 14.

18.

18. LOCATION WORM DAYS ADO DELETE REFERENCE NUMBER FROM TO NUMBER TO BE 6

AS$1GNED BY NRC i

LIST ADDITIONAL WORK SITES ON SEPARATE SHLET(S) TO INCLUDE ALL INFORMATION CONTAINED IN ITEMS 316 ABOVE.

17. UsT RADtOACTIVE MATERIAL, WHICH WILL DE Pos4E&&ED, USED, IN4TALLED, SERVICED, OR TESTED (inedude Wesorgisen er type and gunnery erroshoecew maferief, seeded sowsee, er Wowees se se usesy

[CklYE R

A E CE T OR T

OF SE SPEC IE IN AaOVE. (Four copees or me specific locanae must accompnny the IntUnl NRC Form 241J

19. CERTIFl CATION (MUST BE COMPLETED BY APPLJCANT)

1. THE UNDERSIONED. HERESY CERTIPY THAT:

a.

Allinformation in thle report is true and complete.

b.

I have read and understand the provtsion of the general license 10 CPR 100.20 reprinted on the instructions of th4 form; and I understand that I am required to comply wMh these provis6ons as to all byproduct, rwrce, or special nuclear material which i poseen s.nd use in non-A0reement States or offshore waters under the general l6 cense for which this report la flied with the U.S. Nuclear Regulatory Commission.

I understand that acWttles, including storage, conducted in non-Agreement States under general license 10 CPR 160.20 are limited D s tt;tal of 100 days c.

in calendar year. Wgn theenceptnun of work conducted in off. shore waters, which la authortaed for en unlimited period of time h e calender year, d.

I understand that I may in inspected iy NRC at the above listed work site locations and at the Licensee home office address for activtues performed in non-A0reement States or offshort eers.

I understand that conduct of any activities not described above, including conduct of activities on dates or locatione d4fferent from those described e.

above or wtthout NRC authortzetion, may sub}ect me to enforcement action, including civil or criminal penattles.

CERTIFYING OFFICER. RSO or Menseement Represenesee (Name end Tee) tmeATURE DATE WARNING: False statements in this certificate may be sut> ject to civil and/or criminal penalties. NRC regulations require that subtrussions to the NRC be cornplete and accurate in all material fespects, it U.S.C. Section 1001 makes it a criminal offense to make a willfully falso statement or representation to any department or agency of the United States as to any matter within its jurisdiction.

FOR NE l REVIEWING OFFICIAL (Type #nneed hems end Tse) eiGNATURE DATE TOTAL USAGE - DAfs TO DATE USE ONLY I NRC FOslM 2a1 (MM.YYYY)

PRINTED ON RECYCLED PAPER Thee form wee een gnee uneng o+erme