ML21075A334
| ML21075A334 | |
| Person / Time | |
|---|---|
| Issue date: | 03/18/2021 |
| From: | James Rubenstone NRC/NMSS/DFM/MCAB |
| To: | |
| MShoemaker - NMSS/DFM/MCA - 301.415.7363 | |
| Shared Package | |
| ML21075A325 | List: |
| References | |
| Download: ML21075A334 (1) | |
Text
NRC FORM 742C U.S. DEPARTMENT OF ENERGY APPROVED BY OMB: NO. 3150-0058 EXPIRES: 04/30/2021 (04-2018)
MANDATORY DATA COLLECTION AND Estimated burden per response to comply with this mandatory collection request: 2 hours2.314815e-5 days <br />5.555556e-4 hours <br />3.306878e-6 weeks <br />7.61e-7 months <br /> for small licensees and 6 hours6.944444e-5 days <br />0.00167 hours <br />9.920635e-6 weeks <br />2.283e-6 months <br /> for large licensees. This information is AUTHORIZED BY 10 CFR 30, 40, U.S. NUCLEAR REGULATORY COMMISSION required by NRC to fulfill its safeguards responsibilities, bilateral agreements, and responsibilities as a participant in the US/IAEA Safeguards Agreement. Send comments regarding burden estimate to the Information Services Branch (T-2 F43), U.S. Nuclear Regulatory Commission, Washington, DC 20555-0001, or by e-mail 50, 70,72, 74, 75, 150, to Infocollects.Resource@nrc.gov, and to the Desk Officer, Office of Information and Regulatory Affairs, NEOB-10202, (3150-0058), Office of Management and Public Laws83-703, 93-438, 95-91 PHYSICAL INVENTORY LISTING Budget, Washington, DC 20503. If a means used to impose an information collection does not display a currently valid OMB control number, the NRC may not conduct or sponsor, and a person is not required to respond to, the information collection.
- 1. NAME AND ADDRESS 2. REPORTING IDENTIFICATION SYMBOL (RIS)
STREET ADDRESS CITY STATE ZIP CODE 3. INVENTORY DATE 4. LICENSE NUMBER(S)
- 5. BATCH DATA
- l. m. MEASUREMENT I.D.
- a. b. f. g. h. i. k. n. p. q.
- c. d. e. j. KEY o.
MATERIAL COMP/FAC SCRAP WEIGHT PER- OWNER SEQUENCE NO. OF MEAS. OTHER MEAS. MEAS. ENTRY SITE PROCESS ELEMENT WEIGHT ISOTOPE WEIGHT DOE PROJECT NO. BATCH NAME MEASURE MBA TYPE CODE PROGRAM CENT ISOTOPE CODE NUMBER ITEMS BASIS POINT METHOD STATUS IDC CODE POINT
- 6. TOTALS
- 7. SIGNATURE 8. TITLE 9. DATE WARNING: FALSE STATEMENTS IN THIS CERTIFICATE MAY BE SUBJECT TO CIVIL AND/OR CRIMINAL PENALTIES. NRC REGULATIONS REQUIRE THAT SUBMISSIONS TO THE NRC BE COMPLETE AND ACCURATE IN ALL MATERIAL RESPECTS. 18 U.S.C. SECTION 1001 MAKES IT A CRIMINAL OFFENSE TO MAKE A WILLFULLY FALSE STATEMENT OR REPRESENTATION TO ANY DEPARTMENT OR AGENCY OF THE UNITED STATES AS TO ANY MATTER WITHIN ITS JURISDICTION.
NRC FORM 742C (04-2018) To the best of my knowledge and belief, the information given above and in any attached schedules is true, complete, and correct.