ML21160A214

NRC 7 (OMB Copy) (06-08-2021)

ML21160A214
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Issue date:	06/09/2021
From:	NRC/OCIO
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ML21160A211	List: ML21160A214
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Page 1 of NRC FORM 7 U. S. NUCLEAR REGULATORY COMMISSION APPROVED BY OMB: NO. 3150-0027 EXPIRES: (MM/DD/YYYY)

(MM-YYYY) Estimated burden per response to comply with this mandatory collection request: 2.4 hours4.62963e-5 days <br />0.00111 hours <br />6.613757e-6 weeks <br />1.522e-6 months <br />. This submittal is 10 CFR 110 reviewed to ensure that the applicable statutory, regulatory, and policy considerations are satisfied. Send comments regarding burden estimate to the FOIA, Library, and Information Collections Branch (T-6 A10M), U.S.

APPLICATION FOR NRC EXPORT OR IMPORT Nuclear Regulatory Commission, Washington, DC 20555-0001, or by e-mail to Infocollects.Resource@nrc.gov, LICENSE, AMENDMENT, RENEWAL, and the OMB reviewer at: OMB Office of Information and Regulatory Affairs, (3150-0027), Attn: Desk Officer for the Nuclear Regulatory Commission, 725 17th Street NW, Washington, DC 20503; e-mail:

OR CONSENT REQUEST(S) oira_submission@omb.eop.gov. The NRC may not conduct or sponsor, and a person is not required to respond (See Instructions on Pages 4 and 5) to, a collection of information unless the document requesting or requiring the collection displays a currently valid OMB control number.

Date Received PART A. FOR NRC USE ONLY Public OR Non-Public License Number Docket Number Adams Accession Number PART B. TO BE COMPLETED FOR ALL LICENSES, AMENDMENTS, RENEWALS, OR CONSENT REQUESTS (If more space is needed to complete any of the items, use Pages 3-4 first, and then attach additional sheets, if necessary.)

1. Name and Address of Applicant/Licensee 1a. Name of Applicant's Contact 1b. Applicant's Reference Number 1c. Office Telephone Number 1d. Office Facsimile Telephone Number 1e. Applicant's E-mail Address Export (Parts B, C, E) Amendment/Renewal Current License Number:

2. Type of Action Requested (Check one)

Import (Parts B, D, E) Consent Request (Parts B, C) Current License Number:

3. Contract Number(s) 4. First Shipment Date 5. Last Shipment Date 6. Proposed Expiration Date PART C. TO BE COMPLETED FOR EXPORT LICENSES, AMENDMENTS, OR RENEWALS (If more space is needed to complete any of the items, use Pages 3-4 first, and then attach additional sheets, if necessary.)

7. Name(s)/Address(es) of U. S. Suppliers and/or 8. Name(s)/Address(es) of Intermediate 9. Name(s)/Address(es) of Ultimate Foreign other U. S. Parties to the Export Foreign Consignee(s) Consignee(s) 7a. Function(s) Performed/Service(s) Provided 8a. Intermediate Use(s) 9a. Ultimate End Use(s)

10. Description of Radioactive Materials, Sealed Sources, Nuclear Facilities, 10a. Maximum Total Volume/ 10b. Max Enrichment 10c. Max Isotope Equipment, or Components; for Nuclear Equipment include Total Dollar Value Element WGT (KG), or or WGT% WGT (KG) of Equipment for Export Total Activity (TBq)

11. Foreign origin or obligations by country and, if known, by percentage of maximum total volume (leave blank for byproduct licenses)

NRC FORM 7 (MM-YYYY)

Page 2 of NRC FORM 7 U. S. NUCLEAR REGULATORY COMMISSION (MM-YYYY) 10 CFR 110 APPLICATION FOR NRC EXPORT OR IMPORT LICENSE, AMENDMENT, RENEWAL, OR CONSENT REQUEST(S) (Continued)

License Number Docket Number Adams Accession Number Public OR Non-Public PART D. TO BE COMPLETED FOR IMPORT LICENSES, AMENDMENTS, OR RENEWALS (If more space is needed to complete any of the items, use Pages 3-4 first, and then attach additional sheets, if necessary.)

12. Name(s)/Address(es) of Foreign Suppliers and/or 13. Name(s)/Address(es) of Foreign or U. S. 14. Name(s)/Address(es) of Ultimate other Foreign Parties to Import Intermediate Consignee(s) U. S. Consignee(s) 12a. NRC Export License Number(s) (if applicable) 13a. License Number(s) / Expiration Date(s) 14a. License Number(s) / Expiration Date(s) 13b. Intermediate Use(s) 14b. Ultimate End Use(s)

15. Description of Radioactive Materials, Sealed Sources, Nuclear Facilities 15a. Maximum Total Volume/ 15b. Max Enrichment 15c. Max Isotope Element WGT (KG), or or WGT% WGT (KG)

Total Activity (TBq)

16. Foreign obligations (By country and by Percentage of Maximum Total Volume)

PART E. TO BE COMPLETED FOR ALL LICENSES, AMENDMENTS, RENEWALS OR CONSENT REQUEST(S)

(If more space is needed to complete any of the items, use Pages 3-4 first, and then attach additional sheets, if necessary.)

17. Additional Information provided on pages 3, 4, and/or separate sheets? 17a. Copies of Recipient's Authorizations Provided?

Yes No Yes No

18. Certification:

I, the applicant's authorized official, hereby certify that this application is prepared in conformity with Title10, Code of Federal Regulations, and that all information provided is correct to the best of my knowledge.

18a. Print Name and Title of Authorized Official 18b. Signature -- Authorized Official 18c. Date NRC FORM 7 (MM-YYYY)

Page 3 of NRC FORM 7 U. S. NUCLEAR REGULATORY COMMISSION (MM-YYYY) 10 CFR 110 APPLICATION FOR NRC EXPORT OR IMPORT LICENSE, AMENDMENT, RENEWAL, OR CONSENT REQUEST(S) (Continued)

License Number Docket Number Adams Accession Number Public OR Non-Public Additional Information (Reference applicable block numbers from page 1 and/or page 2 for each entry)

NRC FORM 7 (MM-YYYY)

U. S. NUCLEAR REGULATORY COMMISSION INSTRUCTIONS FOR PREPARATION OF NRC FORM 7, APPLICATION FOR NRC EXPORT OR IMPORT LICENSE, AMENDMENT, RENEWAL OR CONSENT REQUEST(S)

General Instructions: A completed, signed original NRC Form 7 may be mailed to the Deputy Director, Office of International Programs, U.S. Nuclear Regulatory Commission, Washington, DC 20555-0001, hand-delivered to the Deputy Director at 11555 Rockville Pike, Rockville, Maryland 20852, or e-mailed to NRCForm7nrc.gov@usnrc.onmicrosoft.com.

Submitting an electronic signature: An authorized official of the legal entity applying for the License, Amendment or Renewal, must certify the application using an electronic signature such as Adobe Acrobat e-sign. The signed document should then be submitted to the NRC using the e-mail address shown above.

Refer to Title 10 of the Code of Federal Regulations, Part 110, for specific NRC export/import licensing requirements. For each license, amendment or renewal application, and request for exemption identify all foreign and domestic locations where exports or imports will be handled, sorted, repackaged and/or processed in any way. Provide information on quantities, forms, and other characteristics of the radioactive materials, sealed sources, nuclear facilities and equipment to be exported or imported and indicate how they will be used by each of the parties listed. If more space is needed to complete any of the items on this form, use the continuation pages first, and then attach additional sheets. Reference appropriate BLOCK number(s) for each entry on all additional sheets. All applicants should avoid submitting proprietary information unless absolutely necessary, as NRC is required to make copies of all applications received available to the public. If proprietary information must be submitted, follow procedures in 10 CFR 2.390, otherwise, such information could be publicly disclosed and/or processing of an application could be significantly delayed.

An application for a specific license to export or import or a request for an exemption from a licensing requirement must be accompanied by the appropriate fee in accordance with 10 CFR Part 170. The fee schedules are provided in §§ 170.21 and 170.31.

The reference "IMEX" (for import and export) should be included on your form of payment. A license application will not be processed unless the specified fee is received.

All payments of processing fees should be sent to: Pay.gov . This is the preferred web-based utility for application fee payments. After the payment has been submitted to Pay.gov, the applicant will receive a confirmation page, and that page should be submitted along with the NRC form 7 to NRCForm7nrc.gov@usnrc.onmicrosoft.com NOTE: FOR CONSENTS FILL OUT BLOCKS, - CONSENT REQUEST if submitting a request for the NRC to (1a-,2,8,9,10,10a,17,18) obtain government-to-government consent to authorize shipment(s) of Category 1 quantities of byproduct material.

PART A. FOR NRC USE ONLY Include NRC license number in space provided.

PART B. TO BE COMPLETED BY ALL APPLICANTS FOR BLOCK 3. If known, provide contract number(s), which may ALL LICENSES, AMENDMENTS, RENEWALS, OR CONSENT be useful references for example, if reviewers need to contact REQUEST(S) recipients or other parties listed on the application.

BLOCK 4. Enter the anticipated date of the first shipment BLOCK 1. Enter name and complete physical address of the (MM/DD/YYYY).

corporation or other entity with direct control over distribution of proposed export(s) or import(s), and where required records will be BLOCK 5. Enter the anticipated date of last shipment maintained and can be inspected. Post Office Box Numbers or (MM/DD/YYYY).

names of divisions or departments within a legal entity are NOT acceptable entries for this BLOCK. BLOCK 6. Enter a proposed license expiration date (MM/DD/YYYY), to accommodate export activities. Note that NRC licenses are typically issued for 1-5 years.

BLOCKS 1a-e. Provide name and contact information identifying the best party to answer questions about an application. Applicants NOTE: For amendments and renewals, provide only the new or should use BLOCK 1b to assign their own reference number to changed information, as appropriate, in PART C and/or PART D.

identify application documents. (For example, enter names and addresses of parties or consignees, only if they need to be added to, deleted from, or BLOCK 2. Indicate the TYPE OF NRC LICENSING ACTION their information needs to be changed. If seeking to increase the requested by checking:

volume or quantity of material or equipment, specify the

- EXPORT if applying for a new export license. additional increment, and, if applicable, indicate what the new, combined cumulative total will be.)

- IMPORT if applying for a new import license.

PART C. TO BE COMPLETED BY APPLICANTS FOR EXPORT

- AMENDMENT OR RENEWAL if applying to modify or extend an LICENSES, AMENDMENTS, RENEWALS, OR CONSENTS export or import license previously issued by NRC (and not yet expired). Include NRC license number in space provided. If NRC BLOCK 7. Enter names of U. S. supplier(s) and other U. S.

receives an amendment/ renewal application at least 30 days or parties to export not listed in BLOCKS 1, 8, OR 9. Provide more before the license expires, its terms will remain valid and, if complete physical address(es) where correspondence should be circumstances permit, it can continue to be used until NRC sent and where export(s) can be inspected. Post Office Box completes action on the amendment or renewal application. Numbers are NOT acceptable entries for this BLOCK.

U. S. NUCLEAR REGULATORY COMMISSION INSTRUCTIONS FOR PREPARATION OF NRC FORM 7, APPLICATION FOR NRC EXPORT OR IMPORT LICENSE, AMENDMENT, RENEWAL OR CONSENT REQUEST(S) (Continued)

NOTE: U. S. transport/shipping service provider and/or commercial BLOCK 11. For proposed exports or imports (of source or special carrier; do not need to be listed as "Other" U. S. Parties on the nuclear material or nuclear facilities or equipment). Identify each application. These entities are not parties-in-interest to an export country of origin of equipment or materials, and any other license. They serve only as transporters of the nuclear material or countries that have processed the material prior to its import into commodity being exported and their legal responsibility from a the United States, and, if known, the percentage of the maximum regulatory standpoint is limited to complying with NRC's and the total volume that may be obligated to a foreign country (requires Department of Transportation's transportation requirements. If U. S. Government action, e.g., prior notification).

applicants list transport/shipping service providers or commercial PART D. TO BE COMPLETED BY APPLICANTS FOR IMPORT carriers on their applications, they can be identified on the export LICENSES, AMENDMENTS OR RENEWALS license if issued, but that does not convert them into legally responsible formal parties-in-interest to the license. Carriers are BLOCK 12. Enter name(s) and address(es) of foreign supplier(s) not relevant to the NRC's review of an export application to or exporter(s).

determine whether the statutory nonproliferation criteria have been met. BLOCK 12a. For import(s) originally exported under a specific NRC license, enter that license number.

BLOCK 7a. Describe functions to be performed and/or services to be provided by any U. S. parties listed in BLOCK 7. BLOCKS 13a and 14a. Enter NRC or Agreement State Materials BLOCKS 8-9. Enter names and physical address(es) for each License number(s) including expiration date(s) (MM/DD/YYYY) intermediate and each ultimate foreign location. Post Office Box for each U.S. consignee, authorizing receipt, possession, use or Numbers are NOT acceptable entries for these BLOCKS. distribution.

BLOCKS 8a and 9a. Describe how each consignee will use BLOCK 15. Describe key characteristics including physical export(s), including functions to be performed and/or services to be and chemical forms, etc., of radioactive materials (i.e., source, provided. special nuclear or byproduct materials including sealed sources or devices and radioactive waste), and nuclear facilities. For BLOCK 10. Describe key characteristics including physical and radioactive waste, identify and provide maximum total volume in chemical forms, etc., of radioactive materials (i.e., source, special kilograms for each non-radioactive material (e.g., contaminated nuclear or byproduct materials including sealed sources or devices steel) involved, and for each radioactive material contained, and radioactive waste), nuclear facilities, or equipment, uranium, or including its physical and chemical forms for each radioactive thorium, and provide chemical form (e.g., U3O8, Th-227). Identify source, special nuclear or byproduct material. Identify and provide total volume in kilograms of ores containing 0.05% or responsible, and provide industrial process, route(s) of transit, as more of source material (e.g., tantalum, niobium) and specify well as the status of arrangements for disposition in the U.S.,

source material contained. Identify special nuclear material as e.g., any agreement by a low-level waste compact or State to plutonium, high enriched uranium (> 20% U-235) or low enriched accept for management or disposal. For nuclear facilities, uranium (<20% U-235) and specify chemical form (e.g. UF6, U02). provide total quantities; types; names, design power or annual capacity rating; and the estimated combined total dollar value.

Identify Appendix L byproduct materials by name and form, including maximum total activities and types of sealed sources and/ BLOCK 15a. For source and/or special nuclear material, provide or devices to be exported over the license life. Identify Appendix P maximum total volume/element weight over license life in materials by name and form, including maximum total quantities kilograms. For Appendix L byproduct material, including that activity in Terabecquerels (TBq) and types of sealed sources and/or which is in the form of radioactive waste, provide maximum total devices to be exported on a per shipment basis. For radioactive activity over license life in TBq.

waste, identify and provide maximum total volume in kilograms for each non-radioactive material involved, physical and chemical BLOCKS 15b-c. For special nuclear material including that forms for each radioactive material, if exported for the purposes of which is in the form of radioactive waste, provide maximum disposal in a land disposal facility as defined in 10 CFR Part 61, a enrichment/weight % and maximum total isotope weight over disposal area as defined in Appendix A to 10 CFR Part 40, or an license life in kilograms.

equivalent facility; route(s) of transit, forms of management and ultimate disposition. For nuclear facilities, provide total quantity; BLOCK 16. Identify each country and the percentage of the types; names, design power or annual capacity rating; and the maximum total volume that may be obligated to them (require estimated combined total dollar value. For nuclear equipment, U. S. Government action, e.g., prior notification).

identify all items by name, total quantity and function and provide the estimated combined total dollar value. PART E. TO BE COMPLETED BY ALL APPLICANTS BLOCK 10a. For source material, provide maximum total volume/ BLOCK 17. Check YES or NO to verify whether or not additional element weight over license life in kilograms. For special nuclear information is being provided using the space provided on the material, provide maximum total element weight over license life in continuation pages and separate sheets.

kilograms. For each Appendix L byproduct material listed, provide maximum total activity over license life in Terabequerels (TBq). For BLOCK 17a. Check YES or NO to verify whether or not copies of each Appendix P material listed, provide maximum total activity per domestic recipients' authorizations required for Appendix P shipment in Tbq. materials (see Part 110.32 requirements) are included with the BLOCKS 10b-c. For special nuclear material including as application.

radioactive waste, provide maximum weight % (enrichment) and BLOCKS 18a-c. An authorized official of the legal entity total isotope weight over license life in kilograms. applying for the License, Amendment or Renewal, must certify.