ML21340A017
| ML21340A017 | |
| Person / Time | |
|---|---|
| Issue date: | 03/04/2022 |
| From: | NRC/OCIO |
| To: | |
| Baker S | |
| Shared Package | |
| ML21340A014 | List: |
| References | |
| OMB 3150-0036 | |
| Download: ML21340A017 (1) | |
Text
ADVANCED NOTIFICATION OF SHIPMENT OF CATEGORY 1 AND/OR 2 RADIOACTIVE SOURCES In accordance with 10 CFR Part 110.50(c)(3)(ii) of the U.S. NRC Regulations NRC Form 830 (MM-YYYY)
SEND COMPLETED FORM TO:
U.S. Nuclear Regulatory Commission ATTN: Headquarters Operation Center Email: hoo.hoc@nrc.gov (Preferred Reporting Method)
Fax: (301) 816-5151 (Alternative Reporting Method)
A Name of individual and licensee making the notification; address and telephone number:
B Recipient name, location, and address (if different than above):
C Name, location, address, contact name and telephone number for exporting facility:
D Radionuclide(s) and activity level in TBq, both for single and aggregate shipments:
Total Activity Level (TBq):
E Make, model and serial number, for any Category 1 and 2 sealed sources, if available:
F End-use in the U.S.:
G Shipment date from the exporting facility:
(MM/DD/YYYY)
H Estimated arrival date at the end use location:
(MM/DD/YYYY)
NRC or agreement state license number to possess the import in the U.S.:
Expiration date of license: (MM/DD/YYYY)
REPORT OF IMPORT NRC FORM 830 (MM-YYYY) 10 CFR 110.50(c)(3)(ii)
U.S. NUCLEAR REGULATORY COMMISSION APPROVED BY OMB: NO. 3150-0036 EXPIRES: (MM/DD/YYYY)
Estimated burden per response to comply with this mandatory collection request: 30 minutes. This form allows the NRC to request additional information from licensees to determine whether a license should be revoked, suspended, or modified. Send comments regarding burden estimate to the FOIA, Library, and Information Collections Branch, (T-6 A10M), U.S. Nuclear Regulatory Commission, Washington, DC 20555-001, or by e-mail to Infocollects.Resource@nrc.gov, and the OMB reviewer at: OMB Office of Information and Regulatory Affairs, (3150-0036), Attn: Desk Officer for the Nuclear Regulatory Commission, 725 17th Street NW, Washington, DC 20503; e-mail: oira_submission@omb.eop.gov. The NRC may not conduct or sponsor, and a person is not required to respond to, a collection of information unless the document requesting or requiring the collection displays a currently valid OMB control number.
Reference Number:
Comments: