ML20209F975

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Request for OMB Review & Supporting Statement Re NRC Form 313, Application for Matl License, NRC Form 313A, Training & Experience & NRC Form 313B, Preceptor Statement. Estimated Respondent Burden Is 66,652 H
ML20209F975
Person / Time
Issue date: 06/10/1999
From: Shelton B
NRC OFFICE OF INFORMATION RESOURCES MANAGEMENT (IRM)
To:
References
OMB-3150-0120, OMB-3150-120, NUDOCS 9907160196
Download: ML20209F975 (12)
v • d • e


Text

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i Please reed the instruchons before lating this form. For additional forms or cssistance in completing this form, contact agency's Paperwork Clearance

r. Send two copies Cf this form, the conection instrument to be rivizwed, the Statement and cny additional document
  • tion tx Office of infirmitirn end Renultt ry Aff lts, Offisc cf and Busigot, Docket Library, Room 10102,72517th Street NW, Washington, DC 20603.
1. Agency / Subagency originabng request
2. OMB control number a.

3150-0120 b.None U.S. Nuclear Regulatory Commission y

3. Type of enformation cosechon (dieck one)

A Type of review requested (check one)

a. New collechon g
a. Regular
c. Delegated
b. Revision of a currently approved coNection
b. Emergency - Approval requested by (date);
c. Extension of a currently approved couechon
5. Win this information collechon have a e' yo, significant economicimpact on a

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d.

iously approved substan'ial number of small entities?

b.No g

ga.

iously appmved

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a. Three years from approval date e.
f. Existing coNechon in use without an OMB control number
b. Other (Specify):
7. Title NRC Form 313, Application for Material License, NRC Form 313A, Training and Experience, NRC Form 313B,

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Preceptor Statement

8. Agency form number (s) (if appecebie) l l

NRC Form 313, NRC Form 313 A, NRC Form 313B

g. Keywords Radioactive Materials, Radiation Safety
10. Abstract All applicants must submit NRC Form 313 to obtain, renew, or amend a specific license to possess, use, or

" Training and Experience," and NRC Form 313B, distribute byproduct or source material. NRC Form 313A,ical Use oT Byproduct Material," applicants and

" Preceptor Statement," are used for 10 CFR Part 35, "Med licensees along with NRC Form 313 to obtain the above information. The information is reviewed by the NRC to

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determine whether the applicant is qualified by training and experience, and has equipment, facilities, and procedures which are adequate to protect the health and safety of the public, and minimize danger to life and Property.

11. Affacted public paart anmary mm eand an amers mar apery mm x >
12. OtWigation to respond pas,* pnmary mm v and anoews mar app + mm r)

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a. indrviduc.a or househoids
d. Farms
a. Voluntary T
b. Business or other for-profit T
e. Federal Govemment
b. Required to obtain or retaia benefits T
c. Not-for-profit institutions T
f. State. Local or Tribal GovemmentT c. Mandatory
13. Annual reporting and recordkeeping hour burden
14. Annual reportmg and recordkeeping cost burden (in mousands ordomars) 17,958
s. Total annualized capitaustartup costs
a. Number of respondents 9,007
b. Total annual costs (O&M)
b. Total annual responses
c. Total annualized cost requested
1. Percentage of these responses collected electronically 90.0 %
d. Current OMB inventory
c. Total annual hours requested 66,652

.. Difference

d. Current OMS inventory 73,04g
f. Explanation of difference
e. Difference (6.389)
1. Program change
f. Explanation of difference (6,389)
2. Adjustment
1. Programchange
2. Adjustment
15. Purpose of information collection
16. Frequency of recordkeeping or reporting (ch0CA 3 f that apply) 8 (usit pnmary we 'P' and a# omers mal apply we TJ
a. Recordkeeping
b. Third-party disciosure
a. Application for benefits
e. Program planning or management 7
c. Reporting

] 1. On occasion

2. Weekly
3. Monthly

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b. Program evaluation
f. Research
c. General purpose statistics T
g. Regulatory or compliance
4. Quarterly
5. Semi-annually
6. Annually

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d. Audit
7. Biennially 7
8. Other (describe) l Iyear renewal
17. Sta'isticalrnethods
18. Agency contact ws who can cost answer quescons regartring me content or tNs submissoon)

Does this information coNection employ statistical methods?

Name:

Frank Cardile Yes N No 301-415-6185 Phone:

0805 434 The== was oseen a uses inrorms 10/95 9907160196 990610 PDR ORQ EUSOM8 PDR

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 5 CFR 1320.9.

NOTE: 'Ihe text of 5 CFR 1320.9, and the related provisions of 5 CFR 1320.8 (b)(3), appear at the end of the instructions. The certification is to be made with reference to those regulatory provisions as setforth in the instructions.

The 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, coherent, and unambiguous terminology that is understandabh tn nspondents; (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 infonnation is being collected; (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 alloe.ed resources for the efficient and effective 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 (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 Statement.

Sqnature of Authonzed A0ency Ofhcrat Date Sgnatwo of Senior OfRcial or desagnee,)

Date

'helton.

r, Office f the Chef treformation Officer

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Oes 83-1 10/95

PAPERWORK REDUCTION ACT SUBMISSION

~ Des.9W %'"*

5, Please read the instruchons before - fficer.g this form. Fo, Edditional forms or tssistance in completing this form, contSct

's P perwork Clear:nce O Send two as cf this form the coll;ction instrument to be ravirwed, ths ment and cny addition:1 documentation c Office of in Irmition tnd R ttory AffIlrs, Offica cf and Budget, Docket Library, Room 10102,72017th Street NW, Washington, 20503.

1. Agency / Subagency ortgmahng request i 2. OMB control number U.S.' Nuclear Regulatory Commission 7

~

a.

3150.0120 b.None

3. Type of informahon collecten (check one) -
4. Type of revow reques'ed (check one)
s. New collochon g
a. Regular
c. Delegated
b. Revision of a currently approved collechon
b. Emergency - Approval requested by (date);
c. Extension of a currently soproved collechon
5. Will this information collechon have a
n. ye, signrficant economic impact on a
d. Rain

, of usly approved substantial number of smalt entites?

]

b.No e pp ved

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a. Three years from approval date wh se g

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f. Existing collection in use without an OMB control number hWSW
7. Title NRC For:n 313, Application for Material License, NRC Form 313A, Training and Experience, NRC Form 313B, Preceptor Statenient
8. Agency form number (s) (if app 4 cable)

NRC Form 313, NRC Form 313A, NRC Form 313B

g. Keywords Radioactive Materials, Radiation Safety
10. Abstract All applicants must submit NRC Form 313 to obtain, renew, or amend a specific license to possess, use, or distribute byproduct or source material. NRC Form 313A," Training and Experience," and NRC Form 313B,

" Preceptor Statement," are used for 10 CFR Part 35, " Medical Use oT Byproduct Material," applicants and licensees along with NRC Form 313 to obtain the above information. The information is ren,ewed by the NRC to determine whether the applicant is qualified training and experience, and has equipment, facilities, and procedures which are adequate to protect the enith and safety of the public, and minimize danger to life and property.

11. Atfacted pubisc (More pnmary am *P= amt eromes wat awy em =x")
12. Obiegation to respond (Men swrmary mm *P*amt at omus mar nWy em *X')

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a. Individuals or households
d. Farms
a. Voluntary

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b. Business or other for-profit Y
e. Federal Govemment
b. Required to obtain or retain benefits T
c. Not-for-profit institutions T
f. State. Local or Tribal GovemmentT c. Mandatory

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13. Annual reportmg and recordkeeping hour burden
14. Annual reportmg and recordkeeping cost burden (m mousamss ordonars) 17,958
a. Total annualized capitavstartup costs,
a. Number of respondents 9,007
b. Total annual costs (O&M)
b. Total annual responses
c. Total annualized cost requested
1. Percentage of these responses collected electromcally 90.0 %
d. Current OMB inventory
c. Total annual hours requested 66,652
e. Drrference
d. Current OMB inventory 73,041 f.. Explanation of drfference
e. Difference (6,389)

(6,389) us t

P rm ange

2. Adjustment
15. Purpose of information collection
16. Frequency of recordkeeping or reporting (Check aff that apply)

(Hors pnmary we *P' and all others mat apply we "X")

a. Recordkeeping
b. Third-party disclosure
a. Application for benefits
e. Program planning or management 7
c. Reporting

""~~' ] 1. On occasion

2. Weekly
3. Monthly
b. Program evaluation
f. Research
c. General purpose statistics T
g. Regulatory or compliance
4. Quarterty
5. Semi-annually
6. Annually

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d. Audit
7. Biennially 7
8. Other (describe) ITfe' ar renewal
17. Statratical methods
18. Agency contact ry.vwo who can best answer questions regarding the content of mis subenission)

Does this information dellechon employ statistical methods?

Name:

Frank Cardile QNo Yes 301-415-6185 Phone:

ogggu meiarm o gneounneinrarms 10/95 090045 bW ydM

s 4 l~

L Final Supporting Statement for l

Form 313, Application for Material License, Form 313A, Training and Experience, and Form 3138, Preceptor Statement (3150-0120)

Revision to Clearance Extension Request l

Description of the Information Collection i

in order for a person to be licensed to possess, use, or distribute licensed material, the person must submit an application that will permit the NRC to determine whether the applicant has training, experience, equipment, facilities, and procedures for the use of radioactive material that are adequate to protect the public health and safety. NRC Form 313 " Application for Material License,"is used to provide the information required. If the information in the application fulfills i

the substantive requirements stated in the regulations, the NRC issues a license. The j

supp!smental NRC Form 313A, " Training and Experience" and Form 3138, " Preceptor i

Statement" are used by 10 CFR Part 35 applicants and licensees to provide specific information in the areas noted. These forms do not request additionalinformation but merely provide a convenient format for Part 35 licensees to provide the required information.

A.

JUSTIFICATION 1.

Need for and Practical Utility of the Collection of information 10 CFR Sections 30.32,30.37, 30.38, 32.11, 33.12, 34.11,35.12, 36.11, 39.11, 40.31,40.43, and 40.44 provide for the filing of an application for a specific license for possession, use and distribution of byproduct or source material on NRC Form

.313, " Application for Material License." NRC Form 313A, " Training and Experience" and Form 3138, " Preceptor Statement" provide a format that may be used by 10 CFR Part 35 applicants and licensees to provide specific information in the areas noted.

L I

The information submitted on these NRC forms is reviewed by the NRC staff to determine whether the applicant (including those using byproduct material or l

transferring certain items containing byproduct material, applicants for broad scope I

licenses, industrial radiographers, applicants for medical licenses, irradiators, well loggers, and those using source material)is qualified by training and experience and has equipment, facilities, and procedures which are adequate to protect the health and safety of the public and minimize danger to life or property.

2.

Aoency Use of Informatiqn NRC reviews the information submitted in order to determine whether the applicant's training, personnel experience, equipment, facilities, and procedures for the use of byproduct or source material are adequate to protect the public health and safety as required by the Atomic Energy Act, as amended, and the Energy Reorganization Act of 1974, as amended, so that the Commission may determine whether to issue,

' amend, or renew a license.

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I 3.

Beduction of Burden throuah Information Technoloav Th<sre are no legal obstacles to reducing the burden associated with this information collection with the use of information technology. However, there are no current information technology applications that would reduce the burden of these information collection requirements. The NRC encourages applicants and licensees to use new automated information technology when it would be beneficial to them.

However, because of the types of information and the infrequency of submission, the applications may not lend themselves readily to the use of automated information technology for their submission. Consequently, the current percentage of electronic submission is zero.

4.

Effort to identifv Duo!!catian and Use Similar Information The Information Requirements Control Automated System was searched to determine duplication. None was found. The information is not a duplication of other information the affected licensee must submit for other purposes. The nature of the information being requested is unique to licensed activities at the facilities, and is 1

necessary so that the Commission may determine whether to issue, amend, or renew a license.

5.

Effort to Reduce Small Business Burden While a number of licensees are considered small businesses, under the NRC's current definitions, the health and safety consequences of improper use of radioactive material are the same for large and small entities. There is a minimum amount of information that must be provided in order for the Commission to -

determine if an applicant's facilities, equipment, and procedures are adequate to protect the public health and safety. Therefore, it is not possible to reduce the

- burden on small businesses by less frequent submission or less complete applications.

6.

Consecuences to Federal Proaram or Policy Activities if the Collection is not Conducted or is Conducted Less Frecuently Applications for a new license are submitted only once, while applications for renewal of a license are submitted every ten years. Amendments are submitted as needed by the licensee, This is the minimum frequency necessary to ensure that licensees will continue to conduct programs in a manner that will ensure adequate protection of the public health and safety. If the information is not collected, the NRC will have no way to determine the adequacy of licensees' programs to protect the public health.and safety.

. 7.

Circumstances which Justifv Variation from OMB Guidelines There are no variations from OMB guidelines.

2

l 8.

Consultations'Outside the HRC l

An opportunity to comment on the information collection requirements in NRC Forms 313,313A, and 3138 was published in the Federal Reaister Notice on March 29, l

1999 (64 FR 14943). No comments were received..

9.

Payment or Gift to Respondents j

l Not applicable

10. Confidentiality of the InformatioD This information is usually not confidential. If it were, the information would be handled as proprietary in accorc!ance with 10 CFR 2.790 of the NRC regulations.
11. Justification for Sensitive Questions No sensitive information is requ?sted under these regulations.
12. Estimated Burden and Burden Hour Cost A.

NRC Licensees i

lt is estimated that there are 218 new,1,856 amendment, and 448 renewal

]

applications for the possession, use, and initial distribution of byproduct and i

source mateG, for a total of 2522 licensing actions. It is also estimated that each apriscant or licensee will spend an average of about 7.4 hours4.62963e-5 days <br />0.00111 hours <br />6.613757e-6 weeks <br />1.522e-6 months <br /> to complete the appropriate forms. These estimates are based on recent information on the number of licensing actions, on Massachusetts recently becoming an Agreement State, on recent rulemakings, and on the ten-year renewal period.

Costs are estimated at a rate of $121 per hour, which is based on the fee rate charged to materials licensees. Based on the estimated 2522 licensing actions per year, the total industry burden for licensing is estimated to be 18,663 hours0.00767 days <br />0.184 hours <br />0.0011 weeks <br />2.522715e-4 months <br />.

Based on the average time to complete the appropriate forms of about 7.4 hours4.62963e-5 days <br />0.00111 hours <br />6.613757e-6 weeks <br />1.522e-6 months <br /> and a cost rate of $121 per hour, the average annual cost to each respondent to comply with t* - information collection requirements is estimated to be $895. Therefore, the annual cost to all 2522 affected licensees is estimated to be $2,250,199.

B.

Aoreement State Licensees NRC estimi.tes that there are a little over two times the number of Agreement State licensees as tliere are NRC licensees. Therefore, for Agreement State licensees, it is estimated that there are 6485 licensing actions annually based on using a five year renewal period as Agreement State licensees have nc'.

uniformly implemented the ten-year renewal period. Additionally, NRC estimates that the amount of time to complete the appropriate forms and the associated costs will be about the same as for NRC licensees. The total 3

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industry burden for licensing is estimated to be 47,989 hours0.0114 days <br />0.275 hours <br />0.00164 weeks <br />3.763145e-4 months <br />.

)

Based on a cost of $121 per hour, the estimated annual cost to the Agreement l

State licensees to prepare and submit 6485 licensing actions is estimated to be

$5,806,669.

C.

Total Purden and Cost The total burden and burden cost for all licensees is 66,652 hours0.00755 days <br />0.181 hours <br />0.00108 weeks <br />2.48086e-4 months <br /> (18,663 hours0.00767 days <br />0.184 hours <br />0.0011 weeks <br />2.522715e-4 months <br /> + 47,989 hours0.0114 days <br />0.275 hours <br />0.00164 weeks <br />3.763145e-4 months <br />) and 58,064,868 ($2,258,199 + $5,806,669).

j

13. Estimate of Other Additional Cost None
14. Estimated Annualized Cost to the Federal Govemment it is estimated that the review of the information on the appropriate forms will take an average of approximately 7.4 hours4.62963e-5 days <br />0.00111 hours <br />6.613757e-6 weeks <br />1.522e-6 months <br /> per application. Based on an anticipated 2522 licensing actions per year, at a cost of $121 per hour, the cost to perform the i

licensing review would be $2.258,199. This cost is fully recovered through license fees charged to NRC licensees pursuant to 10 CFR Parts 170 and/or 171.

15. Reasons for Chanaes in Burden or Cost There is a small net decrease in the burden and cost to licensees since the last clearance extension, resulting from several changes including: (1) a reduction in the overall number of licensees, (2) the ten-year renewal period for NRC licensees, and (3) inclusion of the burden from the final rules amending 10 CFR Part 34 which affected the radiography licensees subject to 10 CFR 34.11 and 34.13 and 10 CFR Parts 30 and 32 on Exempt Distribution of a Radioactive Drug Containing One Microcurie cf Carbon-14 Urea.
56. Publication for Statistical Use This information will not be published for statistical use.
17. Reason for Not Disolavino the Exoiration Date The expiration date is displayed on NRC Forms 313,313A, and 3138.
18. Exceptions to the Certification Statement There are no exceptions.

B.

COLLECTIONS OF INFORMATION EMPLOYING STATISTICAL METHODS Not applicable.

4

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NRC FORM 313 U. S. NUCLEAR REGULATORY COMMISSION APPROVED LV OMB NO 31504120 EXPIAES LWDony (MM/YY)

Esemated burden per response to compey wtn m.s mtormanon conecton 10 CF2 30. 32, 33 request 7 nours Sutwn=1 of the apphcation is neenwy to dannm. reat 3o53.#and0

m. ap,i. cont,s oua,, sed a,d mai aoe u.te,,ocedu,...sno,r ct me public hea@ and safety Forward comments regarding buroen estimate to the Informa0cn and fleCords Management Branen (T $ F33) y S Nuc. ear APPLICATION FOR MATERIAL LICENSE

"'*ca*"""*"*""*5""

c2 "5 " ' "d'"*** *

  • Reduction Pro,ect (3150 0120) Office of Management and Budget g

Wasnegron. DC 20503 NRC may not conduct or sponsor and a person is not requwed to respond to a colleccon of mformanon unsess d displays a curenlly vahd OMB control nuanber MSTRt.'CTIONS: SEE THE APPROPRIATE LICENSE APPLICATION GUIDE FOR DETAILED INSTRUCTIONS FOR COMPLETING APPLICATION SEND TWO COPIES OF THE ENTIRE COMPLETED APPLICATION TO THE NRC OFFICE SPECIFIED BELOW.

APPUCATION FOR DISTRISUTION OF EXEMPT PRODUCTS FILE APPUCATONS WITH-IF YOU ARE LOCATED IN' 1

DIVISON OF INDUSTRIAL AND MEDICAL NUCLEAR SAFETY p.1NCIS, NDIANA, IOWA, MICH80AN, MINNESOTA, MISSOURI, OHIO, OR WISCONSIN, J

OFFICE OF NUCLEAR MATERIALS SAFETY AND SAFEGUARDS StND APPUCAflONS 10.

U S NUCLE.AR REGULATORY COMMISSON WASHINGTON, DC 20655 0001 MATERIALS LCENSING SECTON U S NUCLEAR REGULATORY COMMISSION REGION m ALL OTHER PERSONS FILE APPUCAT10NS AS FOLLOWS.

301 WARRENVILLE RO If YOU ARE LOCATEC Ft USLE, IL 60532-4351 COfSSCTICUT. DELAWARE,06 STRICT Or COLUtIbA, MAINE, atMtYLANO, ALASMA, ARIZONA, ARKANSAS, CAUFORNLA, COLORADO, MAWAll, IDAHO, KANSAS.

"**aN"TTS, BWM MAMPSHil E NEW JERSEY, NEW YORK. PENNSYLVANIA, LOUISLANA. MONTANA, NEBRASMA, NEVADA, NEW MEXCO, hDRTH DAMOTA, OKLAHOMA, OREGON, PACIFIC TRUST TFMRITORIES, SOUTH DAMOTA, TEXAS, UTAH.

RHOOE ISLAND, OR VERMONT, SENO APPUCATIONS TO-WASHINGTON, OR WYOaHNG, SEND APPUCATONS 70-LICENSING ASSISTANTSECTION NUCLEAR MATENIALS SAFETY BRANCH NUCLEAR MATERIALS LCENSING SECTON U S NUCLEAR REGULATORY COMMISSION. REGON 1 U S NUCLEAR REGULATOR

  • COMMISSON REGION IV 475 ALLENOALE RUAO 611 'lYAN PLAZA DRIVE, SufTE 400 KING OF PRUSSIA, PA 1940S1415 ANUNGTON TX 76011 8064 ALASAMA, FLORIDA, OEORQlA, MENTUCKY, MISSIS $1PPI, NORTH C AROUNA, PUERTO RICO, SOUTH CAROUNA, TENNESSEE, VIRolNIA. VIRON ISLANDS, OR WEST VIRGINIA.

SEND APPUCATONS TO-f NUCLEAR MATERIALS UCENSING SECTON i

U S NUCLEAR REGULATORY COMMISSON REGON il 101 MARIE'TTA STREET, V i SulTE 2900 A1,.ANTA. GA 303250100 PERSONS LOCATED IN AGREEMENT STATES SENO APPUCATIONS TO THE U S NUCLEAR REGULATORY COMMISSON ONLY IF THEY WISH TO POCESS AN3 USE LICENSED MATER!AL IN STATES SUBJECT TO U S NUCLEAR NEGULATORY COMMIS$10N JURISDICTIONS 1

1 THIS IS AN APPUCAflON FOR (Checa appropnele siem) 2 NAME AND MA'Ur4 \\DORESS OF APPLCANT (Incluaelsa code)

A NEW LICENSE AMENDMENT TO UCENSE NUMBER 8

RENEW AL OF UCENSE NUMBER C

4 NAME OF TERSON TO BE CONTACTED ABOUT THas 3 ADDRESS (ES) WHERE LEENSED MATERIAL WILL BE USED OR POSSESSED

/.PPUCATON TELEPHONE NUMBER SUBMIT ITEMS 5 THROUGH 11 ON bit? X 11" PAPER THE TYPE AND SCOPE OF INF0FNA1 ',TO BE PROVIDED IS DESCR! BED IN THE UCENSE APFtlCATON 3 Ult'E 5 RAOCACTIVE MATERIAL.

a Element and mese number b chema and/or pnysicar form and c ma.mmum amount 6 i TE(S) FOR WHICH LICENSED M ATERiAL WILL BE USED mnsch wall be pose 9ssed at any one time T INDIVIDUAL (S) RESPONSIBLE FOR RADI ATON SAFETY PROGRAM AND THEIR TR AINING FOR INDIVIDUALS WORKING IN OR FREQUENTP4G RESTRICTED AREAS 8

TRAINING EXPERIENCE S FACluTIES AND EQUIPMENT 10 R AOIATON SAFETY PROGR AM 12 LICENSEE FEES (See to CFR f 70 and Socison f 70 ?f)

(AMOUNT 11 WASTE MANAGEMENT.

ENCLOSED 5 FEE C ATEGORY (Muar be compmed by appur;entf THE APPUCANT UNDERST ANDS THAT ALL St ATEMENTS AND REPRESENT ATIONS MADE IN fHis APPUCATION ARE BINDING 13 CERTIFCATION UPON THE APPUCANT THE APPUCANT AND ANY OFFICIAL EAECUTING THis CERTIFICATION ON BEHALF OF THE APPUCANT NAMED IN ITEM 2 CERTIFY THAT TK CONFORMITY WTTH TTTLE 10. CODE OF FEDERAL REGULAT1014S, PARTS 30 32. 33,34 E

a. 39 AND 40. AND THAT ALL INFORMAT10tw CC NT AINED HEREIN IS TRUE AND CORRECT TO THE BEST OF THEIR KNOWLEDGE AND BEUEF W ARNING 18 U $ C SECTION 1001 ACT OF.'UNE 251944 62 ST AT 749 MAKES IT A CRIMINAL OFFENSE TO MAKE A WILLFULLY F ALSF STAT ANY DEPARTMENT OR AGENCY OF THE UNrTED STATES AS TO ANY MAT'ER WITHIN ITS JURISDICTION CERTIFYING OFFICER - TYPEDIPRINTED NAME AND TITLE SIGNATURE DATE FOR NRC USE ONLY TYPE OF FEE EE LOG FEE CATbGORY AMOUNT RECDVED CNECK NUMBER COMMENTS APPROVED BY DA TE w#

PRINTED ON HLCYCLED PAPt R NRC FORM 313 (MM/YY)

NRC FORM 313A U.S. NUCLEAR REGULATORY COMMISSION WYYrf)

TRAINING AND EXPERIENCE Note: Descriptions of training and experience must contain sufficient detail to match the training and experience criteria in the applicable regulations.

1. Name of Individual, Proposed Authorization (e.g., Radiation Safety Officer), and Applicable Training Requirements (e.g.,10 CFR 35.50)
2. For Physicians, State or Territory Where Licensed
3. CERTIFICATION Specialty Board Category Month and Year Certified 4
4. DIDACTIC T:tAINING Description of Training l

Location Clock Hours Dates of Training Radiation Physics and instrumentation i

Radiation Protection i

Mathematics Pertaining to the Use and Measurement of RadioactMty Radiation Biology Chemistry of Byproduct Material for Medical Use OTHER l

NRO FORM 313A (WW YYYY)

PMW4TED ON RLCYCLLO PAPLN The form was essegred uteng meorms

1

5. PRACTICAL EXPERIENCE WITH RADIATION (Actual use of radionuclidis cr equivalent experiencs)

Location and Dates and Name of Related Radiation Corresponding Clock Hours Safety Exam Description of Experience Supervising ste is License of Individual gg,,,

Number Experience j

i i

i l

6. FORMAL TRAINING h

Name of Organization that Name of Program and Approved the Program Location with (e.g., Accreditation Council Dates Degree, Area of Study

. Corresponding Materials for Graduate Medical Education)

License Number and the Applicable Regulation (e.g.,10 CFR 35.294) 1 i

l i

e i

I f

iL-

Mtc FORM 3138 U.S. NUCLEAR REGULATORY COMMISSION WWW)

PRECEPTOR STATEMENT Note: Descriptions of training and experience must contain sufficient detail to match the training and experience enteria in the applicable regulations.

This foms must be completed by the individual's preceptor. Ifmore than one preceptoris necessary to document j

experience, obtain a separate preceptor statement kom each.

1. Name of Individual, Proposed Authorization (e.g., Radiation Safety Officer), and Applicabie Training Requirements t

(e.g.,10 CFR 35.50) i

2. ADDRESS
3. SUPERVISED EXPERIENCE OF ABOVE NAMED INDMDUAL Location and Dates and Number of Cases Pond n Radionuclide Type of Use invo y g Pe nal Ma s

nse Number Experience I

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3. SUPERVISED EXPERIENCE OF ABOVE NAMED INDMDUAL (Centinuid)

Numberof Cases Location and Dates and Radionuclide Type of Use inv ng P rsonal Comspon ng Cloc ours g,,

Number Experience i

YES

4. The individual named in item 1. of this form is competent to independently operate a nuclear pharmacy.

D NO Note: Response to this item is only appilcable to proposedauthorizednuclearpharmacists.

YES 5. The individual named in item 1. of this form is competer:t to independently function as an authorized NO y,,,, g,,p,,,,,,,y,,,,,, g,,,,,,pp,,,,y,,,, p,,p,,,g,,,y,,,,,g,,,,,,,,g,,, py,,,,,,,,,,

y redation safety officer for the type of medcal use requested.

6. The training and experience irdicated above was obtained under the supervision of:
7. PRECEPTOR APPROVAL A. NAME OF SUPERVISOR A. NAME OF PRECEPTOR (ptr.;eddearty)

B. ADDRESS B. SIGNATURE -- PRECEPTOR C3dt RIALS UCENSE NUMBER

~

C. DATE

r:

[7590-01-P]

U. S. NUCLEAR REGULATORY COMMISSION i

Agency information Collection Activities: Submission for OMB Review; Comment Request 1

' AGENCY:.

U. S. Nuclear Regulatory Commission (NRC)

ACTION:

Notice of the OMB review of information collection and solicitation of public comment.

]

]

SUMMARY

The NRC has recently submitted to OMB for review the following proposal for the

.' collection ofinformation under the provisions of the Paperwork Reduction Act of 1995 (44 U.S.C. Chapter 35). The NRC hereby informs potential respondents that an agency may not conduct or sponsor, and that a person is not required to

- respond to, a collection of information unless it displays a currently valid OMB control number.

i i

1.

Type of submission, new, revision, or extension: Revision 2.

The title of the information co'iection-NRC Form 313, " Application for Material License.'

l NRC Form 31?A " Training and Experience" NRC Form 313B, " Preceptor Statement" i ep?n#

s"#

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I

. 3.

The form numberif applicable:

NRC Form 313, NRC Form 313A NRC Form 313B 4.

How often the collection is required: There is a one-time submittal of information to receive a license. Once a specific license has been issued, there is a 10-year resubmittal of the information for renewal of the license.

Amendments are submitted as needed by the licensee.

5.

Who wii! be required or asked to report: All applicants requesting a license, and licensees requesting renewal or amendment of a byproduct or source material license to possess, use, or distribute radioactive 1

material.

6.

An estimate of the number of responses: 9007 (2522 NRC licensees and 6485 Agreement State licensecs) 7.

The estimated number of annual respondents: 17,958 (5,556 NRC licensees and 12,402 Agreement State licensees) This is the total number of licensees which could potentially submit licensing actions.

8.

An estimate of the total number of hours needed annually to complete the requirement or request: 66,652 (18,663 hours0.00767 days <br />0.184 hours <br />0.0011 weeks <br />2.522715e-4 months <br /> for NRC 'icensees and 2

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47,989 hours0.0114 days <br />0.275 hours <br />0.00164 weeks <br />3.763145e-4 months <br /> for Agreement State licensees, an average of about 7.4 hours4.62963e-5 days <br />0.00111 hours <br />6.613757e-6 weeks <br />1.522e-6 months <br /> per response).

9.

An indication of whether Section 3507(d), Pub. L.104-13 applias: Not applicable.

J 10.

Abstract: All applicants must submit NRC Form 313 to obtain, renew, or amend a specific license to possess, use, or distribute., byproduct or source material. NRC Form 313A," Training and Experience," and NRC Form 3138, " Preceptor Statement," are used for 10 CFR Part 35, " Medical Use of Byproduct Material," applicants and licensees along with NRC Form 313 to obtain the above information. The information is reviewed by i

the NRC to determine whether the applicant is qualified by training and experience, and has equipment, facilities, and procedures which are adequate to protect the health and safety of the public, and minimize danger to life or property.

l I

A copy of the final supporting statement may be viewed free of charge at the NRC Public Document Room,2120 L Street, NW (lower level), Washington, DC. OMB clearance requests are available at the NRC worldwide web site (http://www.nrc. gov /NRC/PUBLIC/OMB.'index.html).

The document will be available on the NRC home page site for 60 days after the signature date of this notice.

J l

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i Comments and questions'should be directed to the OMG reviewer listed below by (insert date 30 days after publication in the Federal Reaister). Comments received after this date will be considered if it is practical to do so, but assurance of consideration cannot be given to comments recewed after this date.

Erik Godwin Office of Information and Regulatory Affairs (3150-0120)

NEOB-10202 Office of Management and Budget Washington, DC 20503 4

Comments can also be submitted by telephone at (202) 395-3087.

The NRC Clearance Officer is Brenda Jo. Shelton,301-415-7233, Dated at Rockville, Maryland, this 8 day of u-1999.

For the Nuclear Regulatory Commission.

ir -

i

.. L

'~BT6 ride,Jo. SheRon,hearance Officer Office ohhe Chief Information Officer C

s 4

e o.

I I

Comments and questions should be directed to the OMB reviewer listed below by (insert date 30 days after publication in the Federal Reaister). Comments received after this date will be considered if it is practical to do so, but assurance of consideration cannot be given to comments received after this date.

Erik Godwin Office of information and Regulatory Affairs (3150-0120)

NEOB-10202 Office of Management and Budget Washington, DC 20503 Comments can also be submitted by telephone at (202) 395-3087.

The NRC Clearance Officer is Brenda Jo. Shelton,301-415-7233.

Dated at Rockville, Maryland, this /

day of 1999.

For the Nuclear Regulatory Commission.

/ 5)

Brenda.Jo. Shelton, NRC Clearance Officer Office of the Chief Information Officer DOCUMENT NAME: A:\\FRN2_313.OMB

  • See previous concunence.

To receive a copy of this document.-Indicete in the bos: "C* = Copy without attachment / enclosure

  • E" = Copy with attachment > enclosure

'N' = No copy 0FFICE NMSS lE NMSS l

OCIO -

NAME JMMcCausland*

FCardile*

BJStAlt6n_

j DATE 5/29/99 5/28/99 t/

j OFFICIAL RECORD COPY 4

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