ML20198F281

Request for OMB Review & Supporting Statement Re NRC Form 398, Personal Qualification Statement-Licensee. Estimated Respondent Burden Is 1,660 H

ML20198F281
Person / Time
Issue date:	08/01/1997
From:	Levin A NRC OFFICE OF INFORMATION RESOURCES MANAGEMENT (IRM)
To:
Shared Package
ML20198F285	List: ML20198F281 ML20198F290 ML20198F298 ML20198F306
References
OMB-3150-0090, OMB-3150-90, NUDOCS 9708110249
Download: ML20198F281 (10)

Text

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4 PAPERWORK REDUCTION ACT SUBMISSION

• Pteene reed the instrucbons befots complebng the form. Fct addrbord forms cr meestancs in c:mplebng the form, contact your e Paperwork Clearance Omcor, send two copies of the form, the cobochon lnetrument to be rerviewed, the Supporung S ent, and any addibonal documentebon to Omco of information and Regulatory Afte6rs, Omco of Management and Budget, Docket Utuary, Room 10102,72517th Street NW, Washington, DC 20503

1. Agency /Subegency ongmebng request .,,,2,, OMB control number _,,,

U.S. Nuclear Raoulatory Commission X a. 3150 0090 b_ None

,,,,,,3., Type of informahon aan=*an (checA one) _4,, Type of revww r=y ==aad 1; heck one) _,,,

s. New,nnwean X a Regular submession c. Delegated b Revteaan of a cur,ortly approved conecten b Emergency. Approvalrequested by(dete):

c. Edenmon or e currency approved conecten 5 Wis this informaten conecten have a , y,,

4 X fihtoh

' "' e=*= nuel of 7 7 b.No

' e. Reinstelement, tueh cleenge of a provtously approved m X a. Three years from approval date aan=*an for which approves has espired ~

f. Odobne nas-+ n in use wahout en oue coruroi number

1. Ma*#5 d* g%

7. Tuls

} NRC Form 396, " Personal Qualification Statement - Ucensee'

8. Agency form number (e) fireppscam)

NRC Form 398

9. Keywords

! Criminal penalties, manpower training programs, nuclear power plants and reactors, reporting and recordkeeping requirements, operator ficenses.

10 Abstract NRC Form 398 is used to collect information from licensees / applicants seeking to obtain a new, renewal, or reapplication for a license to operate the controls of a nuclear power plant.

] Aflected putdic (tenre prenary em 'P' en_d e# asters Mer esp & we M j rMg=am io reopend (tire punay we 'P'eruf as amers lhet appy we X*)

', e. IrelMduals or houmahoods _

d. Forms n. Volweary

e. FederalGovertenent b. Required to obeam or scene bensees P b aummene er asher Instraat

c. Neder.senet inusieumans

~

f. Sisse. Mt. or Tnbel Government Y c. Mundmoory 14 Annual reporting and recor*==g=ig coat burden (in F-: m eraksrs)

13. Annumi reportbig and resonessapene hour burden

e. Total annumilred capositetertup comes 0 i s. Number of respondants '000

b. Total annual costs (OAM o

b. Toemi annual reopennen 1000

c. Total annustead cost =t-a= 8 o

1. Percarenge of these roepenese eamar*==* eimatronsonny d. Cummt OMB inventory o J qi,

e. Deserence o

c. Tosel annual hours r 1730

', f. Emptanason of deperence

.m ces inversary 1730 1 Pm0" Sh'a0*

l .. Deserence

2. Adlueenant

, f. Espionsoon et duserence

1. Pmerem change

2. Adiumemeal ,

.,; or reportms check e#lhet appry)

15. Purpose of informoson consonen J Frequencyofi _r

b. Third-party desciosure (Mart primary wem "P"and as ashers shot opp #y wfm 'M e. Recor*==fme

e. Appuceann for benmes

e. Pmerem pionnmg or management T c. Reporten0 ~ ~

. '""" 2. Wealdy 3. Monthly

b. Program evolumeen f. Research X 1. On ar'r==m

~

4- Quarterty 5. Sem6-ennueny 6. Annuany

c. General purpose eeneseecs p g. Regulusory or comphence - -

d. Audd 7 g 8.Other descres)

Every s(ix years tocannestuquessonsregansng#w

17. staientical memod. is ggg Does eus information conection employ stahsticei rnemods?

Name.

Roberta K. Ingram, NRR Yes X No pnone. 301-415-1219 ms

! ous as-a 9708110249 970801 PDR ORG EUSOMB PDR

l 1

19. Certification for Paperwork Reduction Act Submissions On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9.

NOTE: ne text of 5 CFR 1320.9, and the related provisions of 5 CFR 1320.8(bX3), appear at the end of the instructions. The certification is to be made with reference to tho;;e regulatory provssion as setforth in the intructions.

He following is a summary of the topics, regarding the proposed collection of information, that the ecstification covers:

(a) It is necessary for the proper perfonnance of agency functions; (b) It avoids unnecessary duplication; (c) It reduces burden on small entities; (d) It uses plain, coherent, and unambiguous terminology that is undentandable to respondents; (e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices; (f) It indicates the retention periods for recordkeeping requirements; (g) It informs respondents of the information called for under 5 CFR 1320.8(bX3):

(i) Why the information is being collected; (ii) Use ofinformation; (iii) Burden estimate; (iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and (vi) Need to display currently valid OMB control number; (h) It was developed by an ollice that has planned and allocated resources for the etTicient and efTective management and use of the information to be collected (see note in item 19 of the instructions).

(i) It uses effective and etTicient statistical survey methodology; and (j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item below and explain the reason in item 18 of the Su;* porting Statement.

l Date Sign ye of Senior Official or designee LNlw 6mm s34 3/k) / to/ss

FINAL SUPPORTING-STATEMENT FOR  ;

NRC FORN 398, ' PERSONAL QUAllFICATION STATEMENT - LICENSEE,"  !

10 CFR PART 55, 655.31, 55.35, 55.47 AND 55.57  !

l (OMB Clearance No. 3150-0090) l Extension DESCRIPTION OF THE INFORMATION COLLECTION l NRC Forn 398 standardizes the essential information needed to apply or reapply for, or to renew an operator's license to operate a nuclear reactor.

A. JUSTIFICATION

1. Need for and Practical Utility of the Collection of Information The regulations in 10 CFR Part 55, 555.31, 55.35, 55.47 and d5.57, specify the use of NRC Form 398 to collect information from licensees / applicants seeking to obtain licenses to operate nuclear reactors.

2. Acency Use of Information The completed NRC Form 398 is reviewed against the licensing criteria to ensure that licensees / applicants meet all the requirements for taking the written examination or operating test; reapplying because of failure to pass the written examination or operating test, or both; or renewing a previous license. The NRC

] Form 398 also provides certification by the authorized facility

representative that the licensees / applicants meet their requirements t

to be licensed as operators, and of the facility's need for them to j be licensed as operators.

The information provided-on the NRC Form 398 is extracted by the

regional / headquarters offices and keyed into the Operator Licensing Tracking System data bank for tracking operator licenses and can be used for generating reports on licensing actions and issuing license and denial letters.

3. Reduction of Burden Throuah Information Technoloav There is no legal obstacle to_ the use of information technology.

Moreover, NRC encourages its use; however, at the current time, no responses _are submitted electronically.

4. Effort to Identify Duolication and Use Similar Information This information is available only from the licensee / applicant and does not duplicate or overlap other information collecticos made by the NRC or other government agencies. The Information Requirements Control Automated System was searched and no duplication was found.

- 5. Effort to Reduce Small Business Burden This information collection does not involve any small businesses.

6. Consecuences to Federal Proaram or Policy Activities if the Collection is not Conducted or is Conducted Less Frecuently The collection of information is occasional and is collected as needed.

7. Circumstances which Justify Variation from OMB Guidelines This information collection does not vary from OMB guidelines.

8. Consultations Outside the NRC On May 28, 1997, NRC published a notice in the Federal Reaister (62 FR 28898) of pending NRC action to submit an information collection request to OMB and solicitation of public comment. No comments applicable to this information collection were received.

l 9. Payment or Gift to Resoondents Not applicable.

10. Confidentiality of Information The NRC Form 398 is filed in the licensee's/ applicant's docket file.

The information is also placed in an NRC data base (Operator Licensing Tracking System). The information is not available for t public inspection.

11. Justification for Sensitive Ouestions No sensitive information normally considered private is requested on NRC Form 398,

12. Estimated Industry Burden and Burden Hour Cost Approximately 600 new,1000 renewal and 60 reapplications are expected to be submitted annually.

Applications for new licenses are to be submitted in total one time only and there is no pre-specified reporting period.

The first reapplication can be filed at least two months after the date of the denial letter. The second reapplication can be filed six months after the date of the set.and denial letter. Successive reapplication can be filed two years nfter the date of the third denial letter and the date of each prior application.

y

1. .,

4 Renewal applications are to be submitted no fewer than thirty days

prior to the expiration of the existing license.

NRC Form 398 is required to be submitted to Headquarters or the appropriate Regional Office.

Records are not required to be retained by the licensees / applicants.

The estimated burden to complete the NRC Form 398 is 2 hours2.314815e-5 days <br />5.555556e-4 hours <br />3.306878e-6 weeks <br />7.61e-7 months <br /> per i initial application, .50 hours5.787037e-4 days <br />0.0139 hours <br />8.267196e-5 weeks <br />1.9025e-5 months <br /> per reapplication and .50 hours5.787037e-4 days <br />0.0139 hours <br />8.267196e-5 weeks <br />1.9025e-5 months <br /> per renewal application. New applications take longer to complete, as it is the first time the appropriate information is collected onto one form. After the initial application, the reapplication and renewals update specific relevant items. Estimates are based on past experience of the respe-dents' actual times to complete the NRC Form 398.

l 2 hours2.314815e-5 days <br />5.555556e-4 hours <br />3.306878e-6 weeks <br />7.61e-7 months <br /> x 600 new applications - 1,200 hours0.00231 days <br />0.0556 hours <br />3.306878e-4 weeks <br />7.61e-5 months <br /> x $131/ hour = $157,200

- annually.

.50 hour5.787037e-4 days <br />0.0139 hours <br />8.267196e-5 weeks <br />1.9025e-5 months <br /> x 60 reapplications - 30 hours3.472222e-4 days <br />0.00833 hours <br />4.960317e-5 weeks <br />1.1415e-5 months <br /> x $131/ hour = $3,930 annually.

. .50 hour5.787037e-4 days <br />0.0139 hours <br />8.267196e-5 weeks <br />1.9025e-5 months <br /> x 1000 renewal applications - 500 hours0.00579 days <br />0.139 hours <br />8.267196e-4 weeks <br />1.9025e-4 months <br /> x $131/ hour -

$65,500

Total annual cost to Industry - 1,730 hours0.00845 days <br />0.203 hours <br />0.00121 weeks <br />2.77765e-4 months <br /> x $131/ hour = $226,630

13. Estimate of Other Additional Costs None.

14. Estimated Cost to the Federal Government Approximately 600 new applications and 60 reapplications are expected to be-submitted by licensees / applicants annually. These numbers are based on the data available from the Operator Licensing i Tracking System. Processing the NRC Form 398 takes .75 hours8.680556e-4 days <br />0.0208 hours <br />1.240079e-4 weeks <br />2.85375e-5 months <br /> per -

i-new application and .50 hours5.787037e-4 days <br />0.0139 hours <br />8.267196e-5 weeks <br />1.9025e-5 months <br /> for each reapplication. The NRC Form 398 processing includes data input, files maintenance =and forms review regarding the eligibility criteria. Data input takes longer for new applications because all data must be entered initially, i whereas for reapplication and renewals, the dats base needs only to be updated. Estimates are based-on staff experience.

600 new-applicants x .75 hour8.680556e-4 days <br />0.0208 hours <br />1.240079e-4 weeks <br />2.85375e-5 months <br /> x $131/ hour = $58,950 annually j 60 reapplications x .50 hour5.787037e-4 days <br />0.0139 hours <br />8.267196e-5 weeks <br />1.9025e-5 months <br /> x $131/ hour - $3,930 annually

t

. 'The renewal period of operators' licenses is six years.

' Approximately-1000 renewal applications are expected annually.

Processing the NRC Form 398 for renewals takes .50 hours5.787037e-4 days <br />0.0139 hours <br />8.267196e-5 weeks <br />1.9025e-5 months <br /> for each

-application. As- stated above, renewal _ applications take less- time  !

to compete than new applications because the data need only be updated. This estimate is based on staff experience.

1000 renewals x .50 hour5.787037e-4 days <br />0.0139 hours <br />8.267196e-5 weeks <br />1.9025e-5 months <br /> x $131/ hour - $65,500 annually, Cost for Operator Licensing Tracking System - $90,000 annually:

Therefore,- the total- annual cost to the Federal Government is  !

expected to be $218,380 ($58,950 + $3,930 + $65,500 = $128,380 +

$90,000 = $218,380).

. Cost to the_ government is fully recovered through fee assessments to 1 NRC licensees pursuant to 10 CFR Parts 170 and/or 171.-

15. Reasons 'or Chanaes in Burden or Cost l The estimated burden remains the same.

16. Publications for Statistical Use  ;

This information is 'not published for statistical use.

17. Reason for Not Disolavina the Exoiration Date The expiration date is displayed.

18. Exceptions to the Certification Statement-None.

1

' B. COLLECTIONS OF INFORMATION EMPLOYING STATISTICAL METH001 i

' Statistical methods are not used in this information collection, 10 CFR 55.31, 10 CFR 55.35 and 10 CFR 55.57 require that applicants use NRC Form 398 to apply or-reapply for or renew-an-operator's111 cense.

Enclosure:

.NRC Form 398 (XX/97)

)

, e

. INSTRUCTIONS FOR COMPLETING NRC FORM 390. PERSONAL QUALFICATION STATEMENT UCENSEE TO REMAIN VAUD, THIS FORM MUST NOT BE ALTERED l

4. TYPE OF APPUCATION

a. IEW . *X* IF YOU ARE A NEW APPUCANT. COMPLETE EACH CATEGORY OF THE FORM COMPLETELY, FOLLOWING THE )

MSTRUCTIONS BELOW. THIS IS TO INCLUDE ALL EDUCA* ION, TRAINING AND EXPERIENCE THAT YOU HAVE RECEIVED UP TO THE DATE OF THis APPUCATION. NOTE: SEE ITEM 12. THERE IS AN EXCEPTION. ALSO, THIS BLOCK IS TO BE MARKED IF PREVIOUS NEW APPUCATION WAS WITHDRAWN. PLEASE WRITE " WITHDREW" NEXT TO *NEW.*

FOR 4 b THROUGH 4.e, COMPLETE EACH CATEGORY COMPLETELY, BUT INDICATE ONLY THE EDUCATION, TRAINING. AND EXPERIENCE YOU HAVE RECEIVED SINCE YOUR LAST APPUCATION, NOTE: SEE ITEM 12.THERE IS AN EXCEPTION.

h. RE9EWAL.*X* IF YOU ARE RENEWING CURRENT LICENSE,

s. UPGRADE.T IF YOU HOLD A RO LICENSE AND ARE NOW APPLYING TO UPGRADE YOUR UCENSE TO A SRO.

eL IIIA.THaff.T F YOU CURRENTLY HOLD A LICENSE AT YOUR FACluTY AND ARE APPLYING TO AMEND YOUR CURRENT UCENSE TO ADO AN AD0fTlONAL UNIT.

e. MAPPUCATION.*X* IF YOU HAVE PREVIOUSLY BEEN DENIED A UCENSE AND ARE REAPPLYING.

L. WARet MelRSTED .T THE APPUCABLE WAlVER REQUESTED ANO JUSTIFY IN COtmENTS SECTION (ITEM 17) l g. DATE PAAESGWWuc PLSEnnheffALS EXAASIATION SECTloN (GFES) . THIS IS NOT APPUCABLE TO RESEARCH REACTORS OR UCENSES LANTED TO FUEL MANDUNG ENTER THE MONTH AND YEAR THE GENERIC FUNDAMENTALS EXAMMATION SECTION OF THE WRITTEN EXAMMATION WAS PASSED. IF THE *FES WAS NOT TAIEN, YOU MUST HAVE PASSED AN NRC UCENSING l EXAMMATION ON THE APPUCABLE REACTOR TYPE (PWR OR BWR) AFTER FESRUARY 1,1982,WHICH LED TO THE ISSUANCE OF A UCENSE. THIS DOES NQI, INCLUDE INSTRUCTOR CERTIFICATION EXAMMATIONS OR REQUALIFICATION EXAMINATIONS.

11. EDUCATION . INDICATE BOTH ACADEMIC AND VOCATIONAUTECHNICAL POST HIGH SCHOOL EDUCATION. FOR MAJOR AREA (S) OF STUDY, INDICATE THE NUMBER OF YEARS SPENT IN EACH COLLEGE CURRICULUM AND THE HIGHEST DEGREE RECEIVED USING THE DEGREE CODE PROVIDED. FOR VOCAT10NAUTEC89ACAL EDUCATION, INCLUDING PROGRAMS SUCH AS NUCLEAR POWER SCHOOL, hALTTARY TRAINING. AIR CONOmONINGIREFRIGERATION, DIESEL hECHANIC SCHOOL, ETC. INDICATE THE NUMBER OF MONTHS IN EACH PROGRAM ANDWHETHER A CERTIFICATE OR DEGREE WAS AWARDED. IF AD0fTlONAL SPACE IS NEEDED, CONTINUE UNDER COMMENTS (ITEM 17).

it. PACUTY OPWRAltst TRApm3 PROGftAM - CHECK THE APPROPRIATE BOX IN ITEMS 12.s AND 12.b. NOTE: INPO ACCREDITED MEANS ACCREDITATION BY THE NATIONAL NUCLEAR ACCREDITING BOARD.

NOTEt IF *YES* 18 CHECKED IN BOTH ITEMS 12.s AND 12.b. THEN ITEMS 13 (TRAINING),14 (EXPERIENCE). AND iS (EXPERIENCE nFTAN si Dn Mnf HAVF TO BF DoctANNTFD.WITH THF FXCFPTION OF Rt OCK 13 2 n AL1 NEW APPUCATIONS flTEM 4a) MUST INCLUDE THE NURSER OF SIGNIFICANT CONTROL MANIPULATIONS WHICH AFFECT REACTMTV OR POWER LEVEL UNDER ITEM 13 3 c

13. TRAINDIS . ALL NEW APPUCATIONS MUST INCLUDE THE NUMBER OF SIGNIFICANT CONTROL MANIPULAY10NS WHICH AFFECT REACTMTY OR POWER LEVEL UNDER ITEM 13.3 c.

ALL REQUAUFICATION TRAINING TIME IS TO BE ACCOUNTED FOR IN THE REQUALIFICATION ITEM 13.6. PLEASE 00 NOT

• DOUBLE UST*

THE TIME SPENT IN REQUAUFICATION TRAINING FOR CLASSROOM OR SIMULATOR TIME UNDER ITEMS 13.1.13.2. OR 13.3.

14. ENpWWGCE . A n4NNUM OF 6 MONTHS AT THE SITE FOR WHICH THE UCENSE IS SOUGHT IS REQUIRED. FOR EACH POSITION HELD, COMPLETE ITEM 15. 00 NOT DOUBLE COutfT TitAE. IF YOU HAD OVERLAPPING DUTIES, THE MONTHS SHOULD REFLECT THE PROPORTIONATE AMOUNT OF TIME YOU WERE ASSIGNED TO THOSE PARTICULAR DUTIES. IN NO CASE SHOULO THE NUMBER OF MONTHS REPORTED FOR A PARTICULAR TIME PERIOD EXCEED THE NUMBER OF MONTHS THAT ARE IN THAT TIME PERIOO.

14. EMPM DETAR.S . INCLUOE POSmON TITLE,TBE PERIOO-FROM/TO, FACluTY AND A BRIEF DESCRIPTION OF DUTIES PERFORMED WHILE SERVING IN THAT POSITION. IF MORE SPACE IS NEEDED,USE COMtAENTS (ITEM 17), OR IF NECESSARY, ATTACH ADDITIONAL INFORMATION,

16. POR REIEWALS OtLY . (1) ENTER THE APPROXIMATE NUMBER OF HOURS SINCE PREVIOUS RENEWAL OR ISSUANCE OF UCENSE IF FIRST RENEWAL (2) ENTER DATE AND RESULT OF MOST RECENT FACILITY REQUAUFICATION EXAMINATION.

17. CORAldENTS . USE THIS SPACE TO INCLUDE ANY EXTRA INFORMATION OR CLARIFICATION FOR OTHER ITEMS ON THE APPUCATION FORM. IF THE SPACE PROVIDED IS NOT SUFFICIENT,YOU MAY ATTACH EXTRA INFORMATION WITH YOUR APPUCATION.

18. 950C FORM 300,CERTFICATION OF MEDICAL EXAMINATION SY FACILITY UCENSEE . MUST ACCOMPANY THIS APPUCATION UNLESS A WAIVER OF THE MEDICAL EXAMINATION IS BEING REQUESTED.

19. SIGNATURES

• SIGN AND DATE ITEM 19 a. OBTAIN YOUR TRAINING COORDINATOR'S SIGNATURE AND THAT Ott YOUR SENIOR MANAGEMENT REPRESENTATIVE ON SITE.

DETACH THESE DISTRUCTIONS AND SUBMIT THE COMPLETED NRC FORMS 398 AND 384 (ORIGINAL AND TWO COPIES EACH) TO THE APPROPNATE REGIONAL ADMemSTRATOR. (SEE REVERSE SIDE FOR ADORESSES OF REGIONAL ADMINISTRATORS AND FOR THE PRNACY ACT STATEMENT.)

meaonmee numvl

. ADDflESSES OF REGIONAL ADMINISTRATORS in ecoWare:s udh 10 CFR 56.5, Communecahons, tNs form shal be submmed to the NRC es fotowe: BY MAIL ADDRESSED TO:

REGIONAL ADMINISTRATOR, REGION If REO40NAL ADMINISTRATOR, RE060N lli REGIONAL ADMINISTRATOR. REGION 1 U S. NUCLEAR REGULATORY COMMISSION U. S. NUCLEAR REOULATORY CLBAAISSION U.S. NUCLEAR REOULATORY mea 40N ATLANTA FEDERAL CENTER 801 WARRENVILLE ROAD 475 ALLENO4LE ROAD LISLE, IL 00532 4351 KING OF PRUSSIA, PA 19408 1415 81 FORSYTH STREET, S.W., SUITE 23Tt6 ATLANTA, GA 30303 3415 U.S. NUCLEAR REGULATORY COMMISSION NONf0WER REO80NAL ADMINISTRATOR RE040N N U.S. NUCLEAR REOULATORY Coted 8SS40N U. S. MUCLEAR REOULATORY rmanalON OPERATOR LICENSING BRANCH.HQ DMS40N OF REACTOR CONTROLS AND NOl@OWER REACTORS AND DECORANSSIONING '

911 RYAN PLAZA DRNE. SUITE 400 PetCMECT DIRECTORATE. NQ ARLINGTOel.TX 79011-8004 HUMAN FACTORS WASHINGTON DC 20506 0001 DMSION OF REACTOR PROGRAM MANAGEMENT WASHueGTON, DC 30508 4 001 PIUVACY ACT STATEb8ENT Pwouse to U.Sc Sean(e)(3), ennned no inw by seeman 3 of the twocy Act of 1974 (Pese Law eSs79), the sessung is heNaned to hereduess who supply Nonneton to he U.S. Nuoteer Regulatory Commienton on NRC Form 308. TNs bdurmeNon is meNehad in a System of Reconde emmyuled as NRC 16 and esmerted se se Pederer negmeer 3eems (My 7, tems), or the most recent Fedene Regisser punncemen of the Nuoiser RegWalary Commleeinn's *Remmocahon of Systems of Records Noeces* that le swassede et the NRC pubile Docwnerd Room, Gelman Buterg, Lawer Lowd 21.0 L 8teet NW, Wenhengto

1. AUTHof4TY. 42 U.S C,2137 and 2201 (1)(1e08).

2. POWICFAL M5FOSES The informenon wil be - and swelushed for delsmaning boensing segtidly and to generale elubeucal data and reports on toenemg oceans.

3. ft0UTBE USES. Informatem erWed on ins form may be used to: (a) detenNne N the indvidual meets the t- ' _-3 of 10 CFR Part 56 to be issued en gerews kones; (b) prowide rusos'thers with informehon for elabancel evolushans rotated to =dwean, training, and seeminston of .%caly operator leeukte tacey enmagemart usi eWRc4 ft Nemston e areci pu in the teenmed operator requetAcadion proyum; and (d) provide for asummeban and maiorld and chhikomas tem cxstur art informehon may also be diecioned to approprtste Federal, Stee, leoni, or Femign esencias to he estent relevant sul necessary kr en NRC doomion ePaut you or m tu east the Normaten Indoutes a vlotation or paterelal vielsten et leur, in edelen, bdermamon may miso -

be centenaud m to onwee of an odersestrulhe or)sected pmosses to e Canyonelonel ellice to roepend to hair Irupaky modo et your request, or to NRG peed egerts, consenres, and som under caread weh the NRC, on a nee 6404 mew basis,

4. WIDETDER neers name gg 3AAfmATORY OR VOLUBfTAftY Afe EPPECT ON peNWUAL OF 30GT Pft0WWB00 BSOftIAATIDfL h-e la

_ _ of 10 CFR vehremry However,Ito Numaton requested le not prowtdsd, NRC we not be able to ovutuses whether the e meets the q : _

Part 55.

5. SYSTEhes RAANAGEftlS) Ape ADDIWas. CNef, Operusar uoerumg Branch, Dewteion of Reedor e and Licereas Performance, Ofhoe of Nucieer Reactnr Reguisuon, U.S. Nucseer Reguistory Cor.wnlosion, WesNngton, DC 2068H001.

e ,0 U i ,cuAR =OuLAn= COM Ss.O A,-mo .T O.= a. cx,,o uO mi

wm --,e,- _ . , .3,, eAs e ne .oAn RECEm.,o e -m,W,ed wie, O CN GL31. GLM. esquest^^82 poemma Idic seosras e*emaann m ennwe sw Edl, brud ** of ---------- meed 2 em ammmg 3-PERSONAL QUAUFICATION STATEMENT-UCENSEE g MR=

Paperwork P-- 1

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. Onna at eennaeumwn are Isudget. Wem8wgasm. CC NRC essutui er spanne. and a TO f4 MAIN VADO THtS FORM MUST NOT BE AtTERtD * * * " " , " ' 'g,,,,,*gy.

~ ***"

1. APPUCANTS RAL NAME Ilest. Frst Mdhe) Ape ADORESS (nriudellP Code! 4. TYPE OF APPUCATION Chace appecaese lNOT l lCOLO ]

e NEW l f WANER RECUE$TED (Just4 on ReverseI ti RENEWAL q . WRITTIN KategoryJ I

s. UPGR M _

~

d MULTIUNIT 4AWND TO

_ NCu a a m mat - n -

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. = m uCAnON _

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, ..RRn _

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2. CITUffeBN 3. BetTH DATE 3.gEcoso 5 0THER

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. . T eRO L _ 9.U.cnO ^E*=l,?A m ac ,,,AnO,, ** vv

. 0T AmcA=u l l I i I S. TV9 J OF N APPLRD POR S. P'WVIOUS N N

. OPERATOR . DocutpeUweER no ano k LKTNSE NUMSER @'" 7 . et F ACILITY DOCuT NUMBE R tk SEseIOR OPERATOR I 3 3 j eL LaerTto SRO an.p. Fwed Nariseerf i 7. NAAAE AAm ADDRESS OF AP90 CANT'S EmePLOYER (include 22P Codel 10. CURRENT POSET10ef AT FACILITY s PLANT SUPERINTINDENT 1. AuxluARY UNIT OPE R.

- ATOsvTRAmEE/ TURBINE b ASSIST ANT PtANT SUPf Rtorit NDE NT guttaesstOUIPME NT OrtRATOR (NON iICT NS-t O O*tRA TOR) d STAFF iNGINE E R 4 OTHER (SpecW)

8. NAAIE OF K.PPLICANT'S FACK1TY e SHIFT TECHNICAL ADvthOfV5HiFT ENGINEER l F ActuTV Docs.ET NUMBE R

f. INS 11UCTOR G. ADOEDONAL F ACA1TY DOCKETS (Muftsienet tacenses) SENtOR WTRM ROOM Or-(RATOR to CONTROL ROOM OPERATOR

11. EDUCATIOel

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