ML19127A378

NRC 831 (OMB Copy)

ML19127A378
Person / Time
Issue date:	05/29/2019
From:	NRC/OCIO
To:
References
Download: ML19127A378 (1)

Text

ADVANCED NOTIFICATION OF SHIPMENT OF CATEGORY 1 AND/OR 2 RADIOACTIVE SOURCES In accordance with 10 CFR Part 110.50(c)(3)(i) of the U.S. NRC Regulations NRC Form 831 (MM-YYYY)

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)

A Part 110 license number:

B Name of the individual and licensee making the notification: (address, city, state, zip code and

telephone number)

U. S. exporting facility:

(company name, address, city, state, zip

code and telephone number)

C Foreign recipient name, address and end use

location(s) if different than recipient's address:

D Radionuclide(s) and activity level in TBq, both

for single and aggregate shipments:

Total Activity Level (TBq):

E Make, model and serial number, for any

category 1 and 2 sealed sources, if available:

F End-use in the importing country, if known:

G Shipment date: (MM/DD/YYYY)

H REPORT OF EXPORT NRC FORM 831 (MM-YYYY)10 CFR 110.50(c)(3)(i)

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

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 Information Services Branch, (T-6 A10M), U.S. Nuclear Regulatory Commission, Washington, DC 20555-001, or by e-mail to Infocollects.Resource@nrc.gov, and to the Desk Officer, Office of Information and Regulatory Affairs, NEOB-10202, 3150-0036, Office of Management and Budget, Washington, DC 20503. If a means used to impose an information collection does not display a currently valid OMB control number, the NRC may not conduct or sponsor, and a person is not required to respond to, the information collection.

This notification should be accompanied by a copy of the foreign recipient's authorization or confirmation of that authorization from the government of the importing country, as required by 110.32(g).

Reference Number:

Comments: Expiration date: