ML23193B006
| ML23193B006 | |
| Person / Time | |
|---|---|
| Issue date: | 07/12/2023 |
| From: | NRC/NMSS/DMSST |
| To: | |
| References | |
| OMB 3150-0223 | |
| Download: ML23193B006 (1) | |
Text
MANUAL LICENSE VERIFICATION REPORT NRC FORM 749 (MM-DD-YYYY)
U.S. NUCLEAR REGULATORY COMMISSION NRC FORM 749 (MM-DD-YYYY)
Sections A-B to be completed by LVS Help Desk (if applicable). Sections C-D to be completed by the licensee: Complete sections C and D below for NRC or Agreement State licensees needing to verify a license outside of the License Verification System. For issues with submitting this form, please contact the LVS Help Desk: 1-877-671-6787 or E-mail: lvshelp.resource@nrc.gov.
A. CONTACTED VIA Phone Email B. DATE (MM/DD/YYYY)
C. TRANSFERRING LICENSEE INFORMATION C.1 Agency (issuing Agency for license)
C.2 Licensee Name C.3 License Number C.4 Contact Name and Title C.5 Contact Telephone Number C.6 Contact Email Address C.7 Contact Fax Telephone Number D. RECEIVING LICENSEE INFORMATION D.1 Agency (issuing Agency for license)
Estimated burden per response to comply with this collection request: 6 minutes. This form is a voluntary means of fulfilling the requirements in 10 CFR 37.71. The information provided will be used to perform a license verification prior to transfer. 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, (3150-0223), Attn: Desk Officer for the Nuclear Regulatory Commission, 725 17th Street NW, Washington, DC 20503; email: 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.
EXPIRES: (MM/DD/YYYY)
APPROVED BY OMB: NO. 3150-0223 D.2 Licensee Name D.3 License Number D.4 Amendment Number D.5 Issue Date D.6 Authorized Location D.7 Material(s) of concern being requested D.8 Chemical/Physical Form D.9 Quantity/Activity/Unit (being requested) 1.
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Sections E-F instructions (Agency representative to provide): Verify the information in Section D above and make sure that all information provided is valid and the authorized location, materials and quantities being requested are authorized on the recipient's license. Record the verification outcome below. Return the completed form via e-mail to the LVS Help Desk (lvshelp.resource@nrc.gov).
E. VERIFIER'S INFORMATION E.1 Verifier's Name E.2 Verifier's Telephone Number E.3 Verifier's Fax Telephone Number E.4 Verifier's E-mail Address F. VERIFICATION OUTCOME F.1 Verification Date F.2 Verification Outcome Requested materials, quantities, and authorized location are authorized on the license Requested materials, quantities, and authorized location are not authorized on the license Other F.3 If other, please explain:
OFFICIAL USE ONLY - SECURITY-RELATED INFORMATION OFFICIAL USE ONLY - SECURITY-RELATED INFORMATION 10 CFR 37.71 Submit by Email