|
---|
Category:Administrative Form
MONTHYEARML24009A2292024-01-25025 January 2024 NRC Form 896 - Topical Report Verification on the Radiological Fuel Qualification Methodology for Dry Storage Systems ML22322A1312022-10-28028 October 2022 NRC Form 653 - Transfers of Industrial Devices Report (to General Licensees) ML22167A1642022-08-0303 August 2022 OMB Copy NRC Form 314 ML22193A1682022-07-11011 July 2022 2022 NRC 620 Certification for 10 CFR Part 60 ML22214B6492022-07-11011 July 2022 Cz USA, NRC 532 - Ssd 22 17 ML22074A2872022-05-26026 May 2022 NRC Form 244 ML22117A2142022-04-26026 April 2022 NRC Form 620 for OMB Clearance No. 3150-0120, NRC Form 313 ML22028A0152022-03-25025 March 2022 NRC Form 653, 653A, 653B (OMB Copy) - Transfer of Industrial Devices Report (to General Licensees) ML20252A1332020-09-0808 September 2020 Nuclear Materials Relief Request Online Form ML19289B9592019-10-24024 October 2019 Defense Threat Reduction Agency Approval Form ML19164A1182019-06-13013 June 2019 Environmental Resource Associates NRC 532, Mcn: 612433 ML19063B1642019-04-0101 April 2019 NRC 313A (Aud) - Authorized User Training, Experience and Preceptor Attestation ML19063B1672019-04-0101 April 2019 NRC Form 313A, Radiation Safety Officer of Associate Radiation Safety Officer Training, Experience and Preceptor Attestation ML19063B1682019-04-0101 April 2019 NRC Form 313A (Aus) - Authorized User Training, Experience and Preceptor Attestation ML19063B1692019-04-0101 April 2019 NRC Form 313A, Authorized User Training, Experience, and Preceptor Attestation ML19063B1722019-04-0101 April 2019 NRC Form 313A (AMP) - Authorized Medical Physicist or Ophthalmic Physicist, Training, Experience and Preceptor Attestation ML18135A2152018-08-14014 August 2018 NRC Form 244, Registration Certificate - Use of Depleted Uranium Under General License 2024-01-25
[Table view]Some use of "" in your query was not closed by a matching "". Category:NRC
MONTHYEARML24009A2292024-01-25025 January 2024 NRC Form 896 - Topical Report Verification on the Radiological Fuel Qualification Methodology for Dry Storage Systems ML22322A1312022-10-28028 October 2022 NRC Form 653 - Transfers of Industrial Devices Report (to General Licensees) ML22167A1642022-08-0303 August 2022 OMB Copy NRC Form 314 ML22193A1682022-07-11011 July 2022 2022 NRC 620 Certification for 10 CFR Part 60 ML22214B6492022-07-11011 July 2022 Cz USA, NRC 532 - Ssd 22 17 ML22074A2872022-05-26026 May 2022 NRC Form 244 ML22117A2142022-04-26026 April 2022 NRC Form 620 for OMB Clearance No. 3150-0120, NRC Form 313 ML22028A0152022-03-25025 March 2022 NRC Form 653, 653A, 653B (OMB Copy) - Transfer of Industrial Devices Report (to General Licensees) ML20252A1332020-09-0808 September 2020 Nuclear Materials Relief Request Online Form ML19289B9592019-10-24024 October 2019 Defense Threat Reduction Agency Approval Form ML19164A1182019-06-13013 June 2019 Environmental Resource Associates NRC 532, Mcn: 612433 ML19063B1642019-04-0101 April 2019 NRC 313A (Aud) - Authorized User Training, Experience and Preceptor Attestation ML19063B1672019-04-0101 April 2019 NRC Form 313A, Radiation Safety Officer of Associate Radiation Safety Officer Training, Experience and Preceptor Attestation ML19063B1682019-04-0101 April 2019 NRC Form 313A (Aus) - Authorized User Training, Experience and Preceptor Attestation ML19063B1692019-04-0101 April 2019 NRC Form 313A, Authorized User Training, Experience, and Preceptor Attestation ML19063B1722019-04-0101 April 2019 NRC Form 313A (AMP) - Authorized Medical Physicist or Ophthalmic Physicist, Training, Experience and Preceptor Attestation ML18135A2152018-08-14014 August 2018 NRC Form 244, Registration Certificate - Use of Depleted Uranium Under General License 2024-01-25
[Table view]Some use of "" in your query was not closed by a matching "". Category:OMB Clearance Material
MONTHYEARML24053A1032024-08-22022 August 2024 Final Rule ASME 2021-2022 Congressional Review Act Summary ML24151A3532024-07-29029 July 2024 Final OMB Supporting Statement for Part 72 Information Collection Renewal ML24191A4522024-07-0909 July 2024 NRR E-mail Capture - Opportunity to Review and Comment on an NRC Information Collection (10 CFR Part 140) (3150-0039) ML24059A0322024-05-14014 May 2024 OMB 3150-0016, Supplemental Burden Spreadsheet for 10 CFR Part 31 ML24059A0342024-05-14014 May 2024 OMB 3150-0016, Supporting Statement for 10 CFR Part 31, General Domestic Licenses for Byproduct Material - Draft ML23339A0742024-01-24024 January 2024 2023 Final OMB Collection Supporting Statement Part 63 ML23142A1772023-11-15015 November 2023 OMB Clearance 3150-0206 Draft Supporting Statement for Comprehensive Decommissioning Program ML21200A1902023-11-0909 November 2023 Rulemaking: Final Rule: Part 52 OMB Supporting Statement Emergency Preparedness for Small Modular Reactors and Other New Technologies ML21200A1852023-11-0909 November 2023 Rulemaking: Final Rule: Part 50 OMB Supporting Statement Emergency Preparedness for Small Modular Reactors and Other New Technologies ML22336A2312023-04-12012 April 2023 Draft OMB Supporting Statement for 10 CFR Part 34 Licenses for Radiography and Radiation Safety Requirements for Radiographic Operations ML22336A2322023-04-12012 April 2023 OMB-3150-0007 10 CFR Part 34 Supplemental Document - Burden and Responses Tables ML22208A0022023-03-0303 March 2023 Draft Supporting Statement for Information Collections Contained in Proposed Rule: Renewing Nuclear Power Plant Operating Licenses - Environmental Review ML23033A4812023-02-0202 February 2023 OMB 3150-0130, Draft Supporting Statement for 10 CFR Part 39, Licenses and Radiation Safety Requirements for Well Logging ML22318A1272023-01-0303 January 2023 Final OMB Supporting Statement: NRC Form 314 ML22199A0042022-11-18018 November 2022 OMB-3150-0001, Final Supporting Statement for 10 CFR Part 32, Specific Domestic Licenses to Manufacture or Transfer Certain Item Containing Byproduct Material ML22306A0622022-11-15015 November 2022 NRC Form 313A (AMP) for OMB Renewal 2022 ML22179A3362022-10-12012 October 2022 OMB 3150-0183, Draft Impep Supporting Statement and Questionnaire ML22117A2072022-08-16016 August 2022 OMB 3150-0120, Supporting Statement Draft for NRC Form 313 Application for Materials License, and NRC Forms 313A ML22201A1252022-08-0404 August 2022 Final Supporting Statement for Cooperation with States at Nuclear Power Plants (2022 Renewal) ML22167A1642022-08-0303 August 2022 OMB Copy NRC Form 314 ML22004A0152022-07-29029 July 2022 Rulemaking - Final Rule - OMB Supporting Statement for NuScale Small Modular Reactor Design Certification ML22045A4792022-07-29029 July 2022 Rulemaking: Final Rule: Congressional Review Act Summary for Enhanced Weapons, Firearms Background Checks, and Security Event Notifications ML22139A3362022-07-15015 July 2022 OMB 3150-0198, 2022 Final Supporting Statement for NRC Form 664, General Licensee Registration ML22078A0032022-07-13013 July 2022 OMB 3150-0017 Draft Supporting Statement for 10 CFR Part 30, Rules of General Applicability to Domestic Licensing Byproduct Material ML22193A1682022-07-11011 July 2022 2022 NRC 620 Certification for 10 CFR Part 60 ML22117A2142022-04-26026 April 2022 NRC Form 620 for OMB Clearance No. 3150-0120, NRC Form 313 ML22028A0152022-03-25025 March 2022 NRC Form 653, 653A, 653B (OMB Copy) - Transfer of Industrial Devices Report (to General Licensees) ML22034A9892022-03-16016 March 2022 Final Supporting Statement for Nuclear Material Events Database OMB Clearance (3150-0178) ML21355A1332022-02-11011 February 2022 OMB 3150-0198, Draft Supporting Statement for NRC Form 664, General Licensee Registration ML22020A1552022-02-11011 February 2022 OMB 3150-0198, NRC Form 664 (OMB Copy) ML21204A1642022-02-10010 February 2022 Draft Supporting Statement for 10 CFR Part 40 Information Collection Renewal, 2022 ML21208A1322022-02-10010 February 2022 NRC Form 620 for 10 CFR Part 40 Information Collection Renewal 2022 ML22024A2572022-01-24024 January 2022 2022 Draft Supporting Statement OMB Information Collection for 10 CFR Part 60 ML21350A3742021-12-16016 December 2021 Form 620 Approval for Information Collection from Brian Anderson Chief, Nmss/Msst/Slpb Dated 12/16/21 ML21193A1502021-08-0606 August 2021 Final OMB Supporting Statement for Requests to Agreement States and Non-Agreement States for Information (3150-0029) ML20242A0002021-06-25025 June 2021 Rulemaking - Proposed Rule - NuScale Small Modular Reactor Design Certification Supporting Statement for Information Collections (Rin 3150-AJ98; NRC-2017-0029) ML21154A1782021-06-16016 June 2021 Final Supporting Statement for 10 CFR Part 20, (3150-0014) Standards for Protection Against Radiation ML21074A3172021-04-13013 April 2021 Draft Supporting Statement for Requests to Agreement States and Non-Agreement States for Information, OMB 3150-0029 ML20178A4492021-03-24024 March 2021 Rulemaking: Proposed Rule: OMB Supporting Statement: Proposed Rule to Incorporate by Reference American Society of Mechanical Engineers Codes ML21011A2632021-03-16016 March 2021 Supplemental Burden Spreadsheet for 10 CFR Part 31, (3150-0016) ML21054A0432021-03-0101 March 2021 Final Supporting Statement Licenses and Radiation Safety Requirements for Irradiators (3150-0158) ML20345A0712021-02-18018 February 2021 OMB 3150-0132, Part 72 OMB Clearance Renewal - Final Supporting Statement ML20345A0722021-02-18018 February 2021 OMB 3150-0132, Final Burden Spreadsheet for Renewal of 10 CFR Part 72 Information Collection ML20356A2442021-02-0101 February 2021 Draft Supporting Statement for 10 CFR Part 20, (3150-0014) ML20318A0432020-12-15015 December 2020 OMB 3150-0143, Draft Supporting Statement for 10 CFR Part 62, Criteria and Procedures for Emergency Access to Non-Federal and Regional Low-Level Waste Disposal Facilities ML20308A2452020-12-10010 December 2020 OMB 3150-0123, Final Supporting Statement, 10 CFR Part 74, Material Control and Accounting of Special Nuclear Material ML20210M2862020-11-0202 November 2020 Draft OMB Supporting Statement for Part 72 Information Collection Renewal ML20272A2112020-10-19019 October 2020 2020 Final OMB Collection Supporting Statement Part 63 ML20245E5362020-10-0202 October 2020 Draft Supporting Statement for 10 CFR Part 36, (3150-0158) ML20192A0942020-09-29029 September 2020 OMB 3150-0009, Part 70 Burden Tables 2024-08-22
[Table view]Some use of "" in your query was not closed by a matching "". |
Text
NRC FORM 314 U.S. NUCLEAR REGULATORY COMMISSION APPROVED BY OMB: NO. 3150-0028 EXPIRES: 03/31/2023 (06-23-2022)
Estimated burden per response to comply with this mandatory collection request: 30 minutes. This submittal is used by NRC as part 10 CFR 30.36(j)(1);
of the basis for its determination that the facility is released for unrestricted use. Send comments regarding burden estimate to the 40.42(j)(1); 70.38(j)(1);
and 72.54(k)(5)(1)(1) CERTIFICATE OF DISPOSITION FOIA, Library, and Information Collections Branch (T-6 A10M), U.S. Nuclear Regulatory Commission, Washington, DC 20555-0001, or by e-mail to Infocollects.Resource@nrc.gov, and the OMB reviewer at: OMB Office of Information and Regulatory Affairs, OF MATERIALS (3150-0028), 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.
Licensee Name and Address License Number Expiration Date Docket Number A. LICENSE STATUS (Check the appropriate box)
This license has expired. This license has not yet expired; please terminate it.
B. DISPOSAL OF RADIOACTIVE MATERIAL (Check the appropriate boxes and complete as necessary. If additional space is needed, provide attachments)
The licensee, or any individual executing this certificate on behalf of the licensee, certifies that:
- 1. No radioactive materials have ever been procured or possessed by the licensee.
- 2. All activities authorized by this license have ceased, and all radioactive materials procured and/or possessed by the licensee under this license number cited above have been disposed of in the following manner.
- a. Transfer of radioactive materials to the licensee listed below:
- b. Disposal of radioactive materials:
- 1. Directly by the licensee:
- 2. By licensed disposal site:
- 3. By waste contractor:
- c. All radioactive materials have been removed such that any remaining residual radioactivity is within the limits of 10 CFR Part 20, Subpart E, and is ALARA.
C. SURVEYS PERFORMED AND REPORTED
- 1. A radiation survey was conducted by the licensee. The survey confirms:
- a. the absence of licensed radioactive materials
- b. that any remaining residual radioactivity is within the limits of 10 CFR 20, Subpart E, and is ALARA.
- 2. A copy of the radiation survey results:
Date
- a. is attached; or b. is not attached (Provide explanation); or c. was forwarded to the NRC on:
- 3. A radiation survey is not required as only sealed sources were ever possessed under this license, and
- a. The results of the latest leak test are attached; and/or b. No leaking sources have ever been identified.
The person to be contacted regarding the information provided on this form:
Name Title Telephone (Include Area Code) E-mail Address Mail all future correspondence regarding this license to:
C. CERTIFYING OFFICIAL I CERTIFY UNDER PENALTY OF PERJURY THAT THE FOREGOING IS TRUE AND CORRECT Printed Name and Title Signature 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 RESPECT. 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.
CERTIFICATE OF DISPOSITION OF MATERIALS PLEASE READ THESE INSTRUCTIONS BEFORE COMPLETING NRC FORM 314.
Subpart E of 10 CFR Part 20 establishes the radiological criteria for license terminations/decommissioning of facilities licensed under 10 CFR Parts 30, 40, 50, 60, 61, 70, and 72, as well as other facilities subject to the Commission's jurisdiction under the Atomic Energy Act of 1954, as amended, and the Energy Reorganization Act of 1974, as amended.
INSTRUCTIONS Section B, Item 2.
Licensees should describe the specific radioactive material transfer actions. If radioactive wastes were generated in terminating this license, the licensee should describe the disposal actions taken, including the disposition of low-level radioactive waste, mixed waste, greater-than-Class-C waste, and sealed sources.
Section B, Item 2.a.
The information provided concerning the transfer of radioactive material to another licensee should specify the date of the transfer, the name of the licensee recipient, an individual contact name and telephone number for the licensee recipient, and the recipient's NRC or Agreement State license number.
Section B, Item 2.b.
For disposal of radioactive materials, licensees should describe the specific disposal method or procedure (e.g., decay-in-storage). For those cases when radioactive materials are disposed of by a licensed disposal site or by a waste contractor, the licensee should specify the name, address, and telephone number of the licensed disposal site operator or waste contractor.
Section B, Item 2.c.
"Residual radioactivity," as defined in 10 CFR 20.1003, means radioactivity in areas' (structures, materials, soils, etc.) remaining as a result of activities (licensed and unlicensed) under the licensee's control from sources used by the licensee, excluding background radiation. ALARA is defined in 10 CFR 20.1003.
FILE CERTIFICATES AS FOLLOWS:
IF YOU ARE LOCATED IN: IF YOU ARE LOCATED IN:
ALABAMA, CONNECTICUT, DELAWARE, DISTRICT OF ALASKA, ARIZONA, ARKANSAS, CALIFORNIA, COLUMBIA, FLORIDA, GEORGIA, KENTUCKY, MAINE, COLORADO, HAWAII, IDAHO, KANSAS, LOUISIANA, MARYLAND, MASSACHUSETTS, NEW HAMPSHIRE, NEW MISSISSIPPI, MONTANA, NEBRASKA, NEVADA, NEW JERSEY, NEW YORK, NORTH CAROLINA, PENNSYLVANIA, MEXICO, NORTH DAKOTA, OKLAHOMA, OREGON, PUERTO RICO, RHODE ISLAND, SOUTH CAROLINA, PACIFIC TRUST TERRITORIES, SOUTH DAKOTA, TEXAS, TENNESSEE, VERMONT, VIRGINIA, VIRGIN ISLANDS, OR UTAH, WASHINGTON, OR WYOMING.
WEST VIRGINIA.
SEND CERTIFICATES TO:
SEND CERTIFICATES TO:
LICENSING ASSISTANCE TEAM MATERIALS LICENSING BRANCH DIVISION OF RADIOLOGICAL SAFETY AND SECURITY DIVISION OF RADIOLOGICAL SAFETY AND SECURITY U.S. NUCLEAR REGULATORY COMMISSION, REGION I U.S. NUCLEAR REGULATORY COMMISSION, REGION IV 475 ALLENDALE ROAD, SUITE 102 1600 E. LAMAR BOULEVARD KING OF PRUSSIA, PA 19406-1415 ARLINGTON, TX 76011-4511 R1DRSSMail.Resource@nrc.gov r4licensingactionsubmittals@nrc.gov
- Note: The preferred method to submit NRC Form 314 is e-mail. *Note: The preferred method to submit NRC Form 314 is e-mail.
ILLINOIS, INDIANA, IOWA, MICHIGAN, MINNESOTA, MISSOURI, OHIO, OR WISCONSIN, SEND CERTIFICATES TO:
MATERIALS LICENSING BRANCH U.S. NUCLEAR REGULATORY COMMISSION, REGION III 2443 WARRENVILLE ROAD, SUITE 210 LISLE, IL 60532-4352 R3DNMSMAIL.Resource@nrc.gov
- Note: The preferred method to submit NRC Form 314 is e-mail.