ML21340A103

OMB 3150-0036, NRC from 831A (Continuation)

ML21340A103
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: ML21340A103 (1)

Text

NRC Form 831A (MM-YYYY)

Part 110 License Number:

NRC FORM 831A (MM-YYYY) 10 CFR 110.50(c)(3)(i)

U.S. NUCLEAR REGULATORY COMMISSION APPROVED BY OMB: NO. 3150-0036 EXPIRES: (MM/DD/YYYY)

SOURCE 1

ACTIVITY (TBq)

MAKE MODEL SERIAL NUMBER 2

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9 10 11 12 13 14 15 16 17 18 19 20 REPORT OF EXPORT CONTINUATION SHEET 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 OF PAGE NUMBER:

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.

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)

Reference Number:

Expiration Date of Part 110 License Number: