ML21340A020

OMB 3150-0036, NRC Form 831

ML21340A020
Person / Time
Issue date:	03/04/2022
From:	NRC/OCIO
To:
Baker S
Shared Package
ML21340A014	List: ML21340A017 ML21340A019 ML21340A020 ML21340A028 ML21340A103
References
OMB 3150-0036
Download: ML21340A020 (1)

Text

ADVANCED NOTIFICATION OF SHIPMENT OF CATEGORY 1 AND/OR 2 RADIOACTIVE SOURCES In accordance with 10 CFR Part 110.50(c)(3)(i) of the U.S. NRC Regulations NRC Form 831 (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 Part 110 license number:

B Name of the individual and licensee making the notification: (address, city, state, zip code and telephone number)

U. S. exporting facility:

(company name, address, city, state, zip code and telephone number)

C Foreign recipient name, address and end use location(s) if different than recipient's address:

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 importing country, if known:

G Shipment date: (MM/DD/YYYY)

H REPORT OF EXPORT NRC FORM 831 (MM-YYYY) 10 CFR 110.50(c)(3)(i)

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.

This notification should be accompanied by a copy of the foreign recipient's authorization or confirmation of that authorization from the government of the importing country, as required by 110.32(g).

Reference Number:

Comments:

Expiration date: