ML23032A445
| ML23032A445 | |
| Person / Time | |
|---|---|
| Issue date: | 10/30/2024 |
| From: | Office of Nuclear Material Safety and Safeguards |
| To: | |
| References | |
| DRAFT Form 366, Part 53, NRC-2019-0062, RIN 3150-AK31 | |
| Download: ML23032A445 (1) | |
Text
NRC FORM 366 (MM-DD-YYYY)
U.S. NUCLEAR REGULATORY COMMISSION LICENSEE EVENT REPORT (LER)
(See Page 3 for required number of digits/characters for each block)
(See NUREG-1022, R.3 for instruction and guidance for completing this form http://www.nrc.gov/reading-rm/doc-collections/nuregs/staff/sr1022/r3/)
APPROVED BY OMB: NO. 3150-0104 EXPIRES: (MM/DD/YYYY)
Estimated burden per response to comply with this mandatory collection request: 80 hours9.259259e-4 days <br />0.0222 hours <br />1.322751e-4 weeks <br />3.044e-5 months <br />. Reported lessons learned are incorporated into the licensing process and fed back to industry. Send comments regarding burden estimate to the FOIA, Library, and Information Collections Branch (T-6 A10M), U. S. Nuclear Regulatory Commission, Washington, DC 20555-0001, or by email to Infocollects.Resource@nrc.gov, and the OMB reviewer at: OMB Office of Information and Regulatory Affairs, (3150-0104), Attn: Desk Officer for the Nuclear Regulatory Commission, 725 17th Street NW, Washington, DC 20503. 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.
- 1. Facility Name 050 052 053
- 2. Docket Number
- 3. Page 1 OF
- 4. Title
- 5. Event Date Month Day Year
- 6. LER Number Year Sequential Number Revision No.
- 7. Report Date Month Day Year
- 8. Other Facilities Involved Facility Name 050 Docket Number Facility Name 052 Docket Number Facility Name 053 Docket Number
- 9. Operating Mode
- 10. Power Level
- 11. This Report is Submitted Pursuant to the Requirements of 10 CFR §: (Check all that apply) 10 CFR Part 20 20.2201(b) 20.2201(d) 20.2203(a)(1) 20.2203(a)(2)(i) 20.2203(a)(2)(ii) 20.2203(a)(2)(iii) 20.2203(a)(2)(iv) 20.2203(a)(2)(v) 20.2203(a)(2)(vi) 20.2203(a)(3)(i) 20.2203(a)(3)(ii) 20.2203(a)(4) 10 CFR Part 21 21.2(c) 10 CFR Part 50 50.36(c)(1)(i)(A) 50.36(c)(1)(ii)(A) 50.36(c)(2) 50.46(a)(3)(ii) 50.69(g) 50.73(a)(2)(i)(A) 50.73(a)(2)(i)(B) 50.73(a)(2)(i)(C) 50.73(a)(2)(ii)(A) 50.73(a)(2)(ii)(B) 50.73(a)(2)(iii) 50.73(a)(2)(iv)(A) 50.73(a)(2)(v)(A) 50.73(a)(2)(v)(B) 50.73(a)(2)(v)(C) 50.73(a)(2)(v)(D) 50.73(a)(2)(vii) 50.73(a)(2)(viii)(A) 50.73(a)(2)(viii)(B) 50.73(a)(2)(ix)(A) 50.73(a)(2)(x) 10 CFR Part 53 53.1640(a)(2)(i)(A) 53.1640(a)(2)(i)(B) 53.1640(a)(2)(i)(C) 53.1640(a)(2)(ii)(A) 53.1640(a)(2)(ii)(B) 53.1640(a)(2)(iii) 53.1640(a)(2)(iv) 53.1640(a)(2)(v) 53.1640(a)(2)(vii)(A) 53.1640(a)(2)(viii)(A) 53.1640(a)(2)(viii)(B) 53.1640(a)(2)(ix) 10 CFR Part 73 73.77(a)(1)(i) 73.77(a)(1)(ii) 73.77(a)(2)(i)(A) 73.77(a)(2)(i)(B) 73.1200(a) 73.1200(b) 73.1200(c) 73.1200(d) 73.1200(e) 73.1200(f) 73.1200(g) 73.1200(h)
OTHER (Specify here, in abstract, or NRC 366A).
- 12. Licensee Contact for this LER Licensee Contact Phone Number (Include area code)
- 16. Abstract NRC FORM 366 (MM-DD-YYYY)
U.S. NUCLEAR REGULATORY COMMISSION LICENSEE EVENT REPORT (LER) (Continued)
- 13. Complete One Line for each Component Failure Described in this Report Cause System Component Manufacturer Reportable to IRIS Cause System Component Manufacturer Reportable to IRIS
- 14. Supplemental Report Expected No Yes (If yes, complete 15. Expected Submission Date)
- 15. Expected Submission Date Month Day Year
REQUIRED NUMBER OF DIGITS/CHARACTERS FOR EACH BLOCK LICENSEE EVENT REPORT (LER) (Continued)
NRC FORM 366 (MM-DD-YYYY)
BLOCK NUMBER NUMBER OF DIGITS/CHARACTERS TITLE 1
UP TO 127 / 2 LINES FACILITY NAME 2
CHECK BOX FOR 050 OR 052 OR 053 10 TOTAL 5 IN ADDITION TO 050 OR 052 OR 053 DOCKET NUMBER 3
VARIES PAGE NUMBER 4
UP TO 230 / 2 LINES TITLE 5
8 TOTAL 2 FOR MONTH 2 FOR DAY 4 FOR YEAR EVENT DATE 6
9 TOTAL 4 FOR YEAR 3 FOR SEQUENTIAL NUMBER 2 FOR REVISIONS NUMBER LER NUMBER 7
8 TOTAL 2 FOR MONTH 2 FOR DAY 4 FOR YEAR REPORT DATE 8
UP TO 29 -- FACILITY NAME CHECK BOX FOR 050 OR 052 OR 053 10 TOTAL -- DOCKET NUMBER 5 IN ADDITION TO 050 OR 052 OR 053 OTHER FACILITIES INVOLVED 9
1 OPERATING MODE 10 3
POWER LEVEL 11 VARIES CHECK ALL BOXES THAT APPLY REQUIREMENTS OF 10 CFR 12 316 CHARACTERS, 4 LINES FOR NAME 84 CHARACTERS, 4 LINES FOR TELEPHONE LICENSEE CONTACT 13 CAUSE VARIES (UP TO 8) 2 FOR SYSTEM (UP TO 8) 4 FOR COMPONENT (UP TO 8) 4 FOR MANUFACTURER (UP TO 8)
IRIS VARIES (UP TO 10)
EACH COMPONENT FAILURE 14 CHECK 1 BOX THAT APPLIES SUPPLEMENTAL REPORT EXPECTED 15 8 TOTAL 2 FOR MONTH 2 FOR DAY 4 FOR YEAR EXPECTED SUBMISSION DATE 16 48 LINES OF TYPING ABSTRACT U.S. NUCLEAR REGULATORY COMMISSION