NRC Form 398

Personal Qualification Statement form is used for license renewal of Operators. ie 10 CFR 55.57

www.nrc.gov/reading-rm/doc-collections/forms/nrc398info.html

2017 update

The design of NRC form 398 change significantly this year.

• Middle name: the new form using a middle initial rather then a full middle name

Middle name

The use of an Operator's Middle Name shows up at a number of locations but it many ways it stems from the NRC form 398 during license application. The middle name is used on the NRC form 396 with the instruction to state the name as shown on the 398. NRC Report 9 shows a list of current licensees and their middle names. From a few checks, the 398 causes whether the full middle name or middle initial shows on the NRC Report 9.

INSTRUCTIONS FOR COMPLETING NRC FORM 398, PERSONAL QUALIFICATION STATEMENT--LICENSEE

ADDRESSES

In accordance with 10 CFR 55.5, Communications, this form shall be submitted to the appropriate NRC office by mail addressed to:

REGIONAL ADMINISTRATOR, REGION I U.S. NUCLEAR REGULATORY COMMISSION 2100 RENAISSANCE BOULEVARD, SUITE 100 KING OF PRUSSIA, PA 19406-2713

REGIONAL ADMINISTRATOR, REGION II U.S. NUCLEAR REGULATORY COMMISSION 245 PEACHTREE CENTER AVENUE, NE., SUITE 1200 ATLANTA, GA 30303-1257

REGIONAL ADMINISTRATOR, REGION III U.S. NUCLEAR REGULATORY COMMISSION 2443 WARRENVILLE ROAD, SUITE 210 LISLE, IL 60532-4352

REGIONAL ADMINISTRATOR, REGION IV U.S. NUCLEAR REGULATORY COMMISSION 1600 E. LAMAR BOULEVARD ARLINGTON, TX 76011-4511

U.S. NUCLEAR REGULATORY COMMISSION RESEARCH AND TEST REACTORS OVERSIGHT BRANCH DIVISION OF POLICY AND RULEMAKING OFFICE OF NUCLEAR REACTOR REGULATION WASHINGTON, DC 20555-0001

PRIVACY ACT STATEMENT NRC FORM 398 PERSONAL QUALIFICATION STATEMENT LICENSEE

Pursuant to 5 U.S.C. 552(e)(3), enacted into law by Section 3 of the Privacy Act of 1974 (Public Law 93-579), the following statement is furnished to individuals who supply information to the Nuclear Regulatory Commission (NRC) on NRC Form 398. This information is maintained as part of a system of records designated as NRC-16, described at 77 FR 67214 (November 8, 2012), or the most recent Federal Register publication of the NRC's "Republication of Systems of Records Notices" that is located in NRCs Agencywide Documents Access and Management System (ADAMS).

1. AUTHORITY:

42 U.S.C. 2131-2141; 10 CFR Part 55.

2. PRINCIPAL PURPOSE(S):

To ensure that applicants/licensees meet all the requirements for taking reactor operator examinations.

4. WHETHER DISCLOSURE IS MANDATORY OR VOLUNTARY AND EFFECT ON INDIVIDUAL OF NOT PROVIDING INFORMATION:

Disclosing this information is voluntary. However, if the information requested is not provided, NRC will not be able to evaluate whether the applicant meets the requirements of 10 CFR part 55.

5. SYSTEM MANAGER(S) AND ADDRESS:

Chief, Operator Licensing and Training Branch, Division of Inspection and Regional Support, Office of Nuclear Reactor Regulation, U.S. Nuclear Regulatory Commission, Washington, DC 20555-0001.

You must complete items 1-10, 18, and 19, plus changes since your last application, and other items as specified below. For additional guidance refer to NUREG-1021, "Operator Licensing Examination Standards for Power Reactors," or NUREG-1478, "Non-Power Reactor Operator Licensing Examiner Standards."

4. TYPE OF APPLICATION

a. NEW - "X" if you are a new applicant at this facility. Complete items 11-15 (10 CFR 55.31).

b. RENEWAL - "X" if you are renewing a current license. Complete items 12, 13.f, and 16 (10 CFR 55.57); if items 12.a and 12.b are checked "YES," then item 13.f does not have to be completed.

c. UPGRADE - "X" if you hold an RO license and are applying to upgrade your license to an SRO at the same facility. Complete items 12, 13, and 15 relevant to the SRO upgrade.

d. MULTI-UNIT - "X" if you hold a license at your facility and are applying to amend your current license to add an additional unit. Complete item 13 as it applies to unit differences.

e. REAPPLICATION - "X" if you have previously been denied a license. Indicate whether you are reapplying after a first denial, second denial, or third denial. Describe, in detail, in items 13 and 17, the additional training completed since the last denial (10 CFR 55.35). If you previously withdrew an application, check item 4.e.4 and complete items 11-15.

f. WAIVER REQUESTED - "X" the applicable waiver requested and explain/justify in detail in item 17 (10 CFR 55.47). Refer to NUREG-1021 or -1478, as applicable, for additional guidance.

g. DATE PASSED GENERIC FUNDAMENTALS EXAMINATION (GFE) - This is not applicable to research and test reactors or licenses limited to fuel handling (item 5.c), renewal or upgrade applications (items 4.b & c). Enter the month and year you passed the GFE for the type of facility (BWR/PWR) identified in item 8. If you have not passed the GFE, explain in item 17.

11. EDUCATION

For college, enter the major area(s) of study, the number of years spent in each major area of study and the highest degree obtained (using the degree codes listed on the form). For vocational/technical, enter the number of months for each type of training and whether a certificate was awarded. If additional space is needed, use item 17.

12. POWER REACTOR OPERATOR TRAINING PROGRAM

Check the appropriate box in items 12.a and 12.b.

Checking "YES" in item 12.a indicates that you have completed a SAT-based training program that is accredited by the National Nuclear Accrediting Board and meets the education and experience requirements outlined by the National Academy for Nuclear Training in its current guidelines for initial training and qualification of licensed operators.

If "YES" is checked in both items 12.a and 12.b then items 13 and 15 do not have to be completed with the following exceptions: (1) certified instructors seeking an SRO license must complete item 15; (2) any exceptions or waivers from the education and experience requirements outlined by the National Academy for Nuclear Training must be explained in item 17.

13. TRAINING

All requalification training time is to be accounted for in item 13.f (unless items 12.a and 12.b are checked "YES"). Do not "double list" the time spent in requalification training for classroom or simulator time under items 13.a or 13.b.

14. SIGNIFICANT CONTROL MANIPULATIONS

If you are a new applicant (item 4.a), you must provide evidence that you have successfully manipulated the controls of the facility for which a license is sought. Describe (date, time, type, and magnitude) at least five significant control manipulations that affect reactivity or power level and whether the manipulations were performed in the plant or on the simulator (10 CFR 55.31(a)(5), 10 CFR 55.46(c)).

15. EXPERIENCE DETAILS

For each position held, provide position title, time in position (from/to and number of months), facility, and a description of duties performed while in that position. Do not double count time. If you had overlapping duties, the time should reflect the amount of time you were assigned to those particular duties. In no case should the number of months reported exceed the number of months that are in that time period. If more space is needed, use item 17 or attach additional information.

16. FOR RENEWALS ONLY

(a) Check the box that most accurately reflects your approximate number of operating hours since previous renewal or issuance of license if first renewal.

(b) Enter the date and results of your most recent comprehensive written requalification examination and annual operating test (10 CFR 55.57).

17. COMMENTS

Use this space to include any extra information or clarification for other items on the application form. If the space provided is not sufficient, you may attach extra information with your application.

18. NRC FORM 396, CERTIFICATION OF MEDICAL EXAMINATION BY FACILITY LICENSEE, IS ATTACHED - NRC

Form 396 must accompany this application unless a waiver of the medical examination is being requested in item 4.f.4 (10 CFR 55.23).

19. SIGNATURES

You must sign and date item 19.a. Obtain signatures of your training coordinator and your senior management representative on site and have them check block 19.b or 19.c, as directed (10 CFR 55.31, 10 CFR 55.57).

Detach these instructions and submit the completed original NRC Forms 398 and 396 to the appropriate address. (See reverse side for addresses and for the Privacy Act Statement.)