ML20203P961

Request for OMB Review & Supporting Statement Re NRC Form 5, Current Occupational External Radiation Exposure. Estimated Respondent Burden Is 124,740 H

ML20203P961
Person / Time
Issue date:	05/02/1986
From:	Norry P NRC OFFICE OF ADMINISTRATION (ADM)
To:
References
OMB-3150-0006, OMB-3150-6, NUDOCS 8605080426
Download: ML20203P961 (9)

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impartint Read instruct:ons before completing form. Do not use the some SF 83 Send three copies of this form, the material to be teviewed, and for to request botn an Executive Order 12291 review and appeova' und r paperwork-three copies of the supportmg stattment, to:

the Paperwork Reduction Act Answer all questions in Part 1. If this request is for review under E.O. Of f ece of Information and Regulatory Affairs 12291, compiele Part il and sign the regulatory certification. If this Officeof Management anc Budget request is for approval under the Paperwork Redaction Act and 5 CFR Attention: Docket Library, Room 3201 1320, skip Part II. ccmp!ete Part 111 and sign the paperwork certif.ution. Washington, DC 20503 PART l.-Complete This Patt for All Requests.

1. Department / agency and Bureau /of f ece origmating request ~ 2 Ager<y rode U.S. Nuclear Regulatory Comission 3_ _L 5._ 0

3. fume of person who can best ansaer questions rectding tnis request Telephone number R. E. Alexander _

( 301 )443-4370

4. Title of it: formation cotiection or ru'emakir g NRC Form 5, Current Occupational External Radiation Exposure

5. t egal authority for entormation cot'ection or ruie (cite tir'rree %f es Coire, n:Nc Law, or Decuteve Order) 42usc 2_201(o) . or _

6. Affected pub'ic (check allthJt app /p) 5 Federal agencies or employees 1 O individuais or housencids 3 0 re,ns e Non prot.:institut.cas

2 O siateoriocaigovernments -t a sus noses er orner vor.protit 7 0 smaii businesses or organizations NOT APPL.ICABLE TO NRC PART ll.-Complete This Part Only if the Request is for OMB Review Under Executive Order 12291

7. Rrgulation identifier Number (RIN)

____~___ _. or. Ncne ass gned

8. Type of sutimissson (chec k one on each category) Type of review requested CI:ssification Stage ct de velopmsnt 1 0 Standard 1 tAajor 1 0 Pecrosed cr d a't 2 Pending 2 O Nonmajor 2 O r:rwiorinem'inat.witnpriorproposal 3 0 cmergency 3 U FiiJ or ir.ter m i nat, without prior proposal 4 0 statutoryor judicialdeachne

9. CFR section aff ected CFR

10. Does this regulatiori conta.n repo t.r.g or re(crc 6eep rg recure e,ents tnat rr cuire OMB approval under the Paperwork Reduction Act ard 5 CFR 1320? . O ves O to 11.11 a major rule is there a regulatory s". pact anal / sis a'ta&ef 1 O Yes 2 U No if"No," dio oMB maae tne analys s' __

3 0 ves 4 0 Nn C rtific tion for Regulatory Submissions li1 submitting this request for oMB review, the aut"urried are nry contact and the program official certify that tt e requirements of E.o 12291 and any apabcan'e pohey directives have been comphed wat'1

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Date signature of program off.ciai 8605000426 860502 PDR ORG EUDOMB PDR Signature of authorized regu:atory con *act Date

12. TOM 6 use only)

Previous ed*rioris obst>Iete g ;gg standard Ioerri S3 f W 4 M) re.f4 7540 00 634 4034 P'ev r rd : e CYB S Cf R 1320 ano t 0 12/91

PART lli.-Complet? This P rt Only if th9 Requ:st is fir Appr:vtl cf a C:llIction of Informrti:n Undir th) P perwork Reducilin Act end 5 CFR 1320.

I 3. Abstract-Desenbe reeds. uses and atfected pubhc in 50 nords or less

" Nuclear radiation monitoring, radiation exposure" NRC Form 5 is used to recr)rd the current occupational exposure of individuals to ensure that regulatory limits are not exceeded.

14. T,pe of informat on collecton (criec4 only one) informstlon collections not contained in rules i O Regutar submission 2 O Emergency submission (cert:t,caron attached)

Information collections contained in rules 3 0 Existing regulation (no change proposed) 6 Final or intenm final without poor NPRM 7. Enter date of espected or actual Federal 4 Notice of proposed rulemaking(NPRM) A O Regular submission Register publication at this stage of rulemaking 5 0 Final. NPRM was prestously published 8 O Emergency submission (cerr,rication attached > (moata 8er reer):

15. Type of review requested (checa oniy one) 4 0 Remstatement of a previous >y approved coiiection for wnien approvai 1O Newconection as empired 2 O Revision of a currently approved collection 3 3 Extension of the expiration date of a currently approved collection 5 0 Existing collection in use without an oMB control number without any change in the substance or in the method of coHection

16. Agency report form number (s)(,nclude standard /optonal form number (s)) 22. Purpose of information collection (check as many as apply)

NRC Form 5 1 ^DP"****"6'"

2 O Programevaluation

17. Annual report r g or disclosure burden 3 0 .;enersi purpose statistics 1 Number of respondents . 4 % Regulatoryorcompliance 2 Number of responses per respondent 5 O Program planningormanagement 3 Totalannualresponses(hne J tames Ace 21 6 O Research 4 Hours per response 7 O Audit 5 Total hours (kne 3 tomes hne 4)

18. Annualrecorcheepir*gOurden 23. Frequency of recordkeeping or reporting (check all that apply) 1 Number of recordkeepers 7 J00 i10 Recordkeeping 2 Annual hours per recordkeeper. I7 Reporting 3 Total recordkeeping hours (Iine 1 f.rnes hne 2) 124.ZA0_ _ 2 O onoccasion 4 Recordkeeping retenton penod Lifet.jgm years 3 0 weekry

19. Totti annual burden 4 O Montner 1 Requested (hne 17-5 plus hne 18-3) . _ 124,740 5 0 quarteriy 2 in current oMB inventory __62fid67 6 0 semeannuairy 3 0ifference(kne J /ess hne 2) .-551327 7 O Annuaiiy Esplanation of difference 8 0 Bienmall1 4 Program change 9 Other(desenbe);

5 Adjustment . -551J27

20. Current (most recent) oMB controi number or comment number 24. Respondents' obhgation to comply (check the strongest obhgatiorr that appl.es) 3150-0006 i O voiuntary

21. Requested expiration date 2 O Required to obtain or eetain a benefit April 30. 1989 3 G Mandatory

25. Art the respondents pnman8y educational agencies or institutions or is the pnmary purpose of the collection related to Federal education programs? Yes @ No

26. Does the agency use sampling to select respondents or does the agency recommend or prescribe the use of samphng or statistical analysis by rtspondents? . Yes $ No

27. Regulato3 authority for the informaton coitection 0 crR Part 20  : or rR  ; or.other(specsfy):

P;perwork Certification in submitting this request for oMB approval. the agency head, the senior official or an authonfed representative, certifies that the requirements of 5 CFR 1320 the Prryacy Act, statistical standards or directives. and any other applicable information policy directives have been comphed with.

Signature of program off.cial Date Srgnature of agenc y nead, tne semor of ficial or an authonzed representative Date Patricia G. Norry, Director Office of Administration 8 +% OkG O GPO : l'184 0 - 453-776

OMB SUPPORTING STATEMENT FOR NRC FORM 5 CURRENT OCCUPATIONAL EXTERNAL RADIATION EXPOSURE Description of the Information Collection NRC Form 5 is used as a current record of occupational radiation doses for each individual for whom personnel monitoring is required by 10 CFR Part 20.

Section 20.401 requires each licensee to maintain records showing the radiation exposure of all individuals for whom personnel monitoring is required by.

520.202. The records are to be kept on NRC Form 5, in accordance with the instructions contained in that form or on clear and . legible records containing all of the information required by NRC Form 5. The requirements for provision of personnel monitoring equipment are set out in 620.202 in terms of percentages of the dose limits which the individual is likely to receive.

A. JUSTIFICATION

1. Need for the Collection of Information It is essential that licensees maintain records of the occupational doses of their employees in order to establish whether these doses have exceeded the-limits. Dose records are important also for assessment and control of ongoing programs, particularly with respect.to maintaining occupational exposures as

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low as is reasonably achievable and identifying unfavorable trends. In addition, it is in the interest of the worker that~the licensee keep accurate.

dose records. The-licensee.is required to report certain exposure information to a worker, and a worker may request other reports of occupational exposure that flow directly from the NRC Form 5 records.

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2. Agency Use of Information The NRC regulations do not require licensees to send Form 5 to the NRC. These records are to be completed and maintained by.NRC licensees so that they can be reviewed by NRC inspectors during periodic inspections to determine compliance with the dose-limiting sections of the' regulations.

3. Reduction of Burden Through Information Technology Less time is now required to complete NRC Form 5 than during earlier requests for 0MB clearance because of the increased use of computers for recordkeeping.

Many NRC licensees have computer systems in which the radiation exposure information required to be collected can be stored. This allows them to quickly print the information in any desired format.

4. Effort to Identify Duplication The Federal Information Locator System was searched to determine NRC and other Federal agency duplication, and no duplication was found.

5. Effort to Use Similar Information NRC Form 5 is the only available source of information which contains the current record of occupational radiation doses for each individual for whom personnel monitoring is required by 10 CFR Part 20. There is no similar information which can be readily used to satisfy the needs stated in item #1.

6. Effort to Reduce Small Business Burden The information required by NRC Form 5 is needed for all monitored individuals, regardless of the size of the business by which they are employed. It is not possible to reduce the burden on small businesses and still meet the objectives stated in A.1. However, since smaller businesses usually have fewer employees, their recordkeeping burden will be less.

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7. Consequences of Less Frequent Collection The radiation dose limits, specified in 920.101, are in terms of rems per calendar quarter. Because of the quarterly limits, the data recorded on NRC Form 5 are required to be for periods of time not exceeding one calendar quarter. If the data were collected less frequently, identification of those workers who had exceeded the quarterly occupational radiation protection limits would be delayed.

8. Circumstances Which Justify Variation from OMB Guidelines NRC Form 5s are to be preserved by the licensees until the Commission authorizes their disposition because they may, at some time, be necessary to reconstruct an individual's occupational exposure history and the potential health impact due to such exposure.

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9. Consultations Outside the NRC Since the original justification, many individuals (licensees, workers, etc.)

have used, reviewed, or commented on NRC Form 5. However, no significant changes have been made in the form.

10. Confidentiality of Information The NRC provides no pledge of confidentiality for this collection of information. The NRC neither receives nor maintains the information collected on NRC Form 5.

11. Justification for Sensitive Questions The form contains no sensitive questions.

12. Estimated Annualized Cost to the Federal Government NRC cost is incurred by the inspectors reviewing the information on NRC Form 5, or equivalent record, maintained by licensees. An average of 3-

2.5 hours5.787037e-5 days <br />0.00139 hours <br />8.267196e-6 weeks <br />1.9025e-6 months <br /> of inspection time per year is spent reviewing the information on NRC Form 5, or equivalent record, at each of about 70 reactor sites. An average of 0.5 hour5.787037e-5 days <br />0.00139 hours <br />8.267196e-6 weeks <br />1.9025e-6 months <br /> of inspection time per 3 years is spent reviewing such records of about 7,475 materials licensees. Therefore, the total inspection time would be about 1,421 hrs /yr (70 licensees x 2.5 hrs /yr + 7,475 licensees x 0.5 hr/3 yrs), with an associated cost of about $85,260/yr (1,421 hrs /yr x

$60/hr).

13. Estimate of Burden

a. NRC Form 5, or its equivalent, must be completed by all licensees for all individuals requiring provision of individual monitoring devices or services. It is estimated that 7,500 NRC licensees monitor about 300,000 individuals per year, that entries are made on NRC Form 5, or equivalent record, monthly (or whenever they receive the results from dosimetry processors), and that each entry requires about 2 minutes (0.033 hour3.819444e-4 days <br />0.00917 hours <br />5.456349e-5 weeks <br />1.25565e-5 months <br />) for a total of about 118,800 hrs /yr (300,000 individuals x 0.033 x 12 entries / year). An additional 5%, er 5,940 hours0.0109 days <br />0.261 hours <br />0.00155 weeks <br />3.5767e-4 months <br />, is estimated for maintaining each required form or record for a total of 124,740 hours0.00856 days <br />0.206 hours <br />0.00122 weeks <br />2.8157e-4 months <br /> / year.

1. Number of recordkeepers ................... 7,500

2. Annual hours per recordkeeper............... 17

3. Total recordkeeping hours ................. 124,740

4. Recordkeeping retention period ............. until the Commission authorizes their disposition There would be a wide range in the number of forms completed and maintained by each licensee because of the tremendous variation in the size of NRC licensees,

b. The cost of this requirement is estimated to be about $7,484,400 (124,740 hrs x $60/hr). An additional 5%, or $374,220, is allowed for the cost of 4

maintaining the records. The total cost would be $7,858,600/yr.

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Therefore, the estimated annual cost per respondent to respond to the collection is $1000. .

c. The burden data and estimates are judgments of NRC staff based on experience gained as licensees and as regulators.

14. Reasons for Change in Burden Under the current OMB control number 3150-0006, NRC Form 5 has 676,667 total I

recordkeeping hcurs in the current OMB inventory. Under this updated request for clearance, NRC Form 5 will request 124,740 total recordkeeping hours in the OMB inventory.

The diffarence of 551,927 total recordkeeping hours is an adjustment based on NRC staff's judgement that NRC licensees will need 2 minutes for each of 3,600,000 entries per year rather than 10 minutes for each of 4,060,000 entries per year to maintain records of current occupational radiation exposure. The major reason for the reduced time per entry is the increased use of computers to maintain occupational dose records.

15. Publication for Statistical Use Not Applicable.

B. COLLECTION OF INFORMATION EMPLOYING STATISTICAL METHODS Statistical methods are not used in the collection of information.

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NRC Ferm 5 Approved by OMB (10-81) 325041006 10 CFR 20 U. S. NUCLE AR REGULATORY COMMISSION Em a w as CURRENT OCCUPATIONAL EXTERNAL RADIATION EXPOSURE See Instructions on Back IDENTIFICATION

1. N AME (PRINT - Last, first, and m.ddle) 2. SOCI AL SECURITY NO.

3. DATE OF BIRTH (Month, day, year) 4. NAME OF LICENSEE

5. DOSE RECORDED FOR (Specif y: Whole body; 6 WHOLE BODY DOSE 7. METHOD OF MONITORING (e.g., Film Badge -

skin of whole body; or hands and forearms. STATUS (rem) F 8; Pocket Chamber - PC; Calculations - Calc.)

feet and an les.) X OR GAMMA BETA NEUTRONS

8. PERIOD OF EXPOSURE DOSE FOR THE PERIOD (rem) 13.. RUNNING TOTAL FOR (From - Tol CALENDAR QUARTER

9. X OR GAMMA 10. BET A 11. N EUTRON 12. TOTAL (rem) i i

I LIFETIME ACCUMULATED DOSE

14. PREVIOUS TOTAL 4eems 15 TOTAL OUARTERLY 16 TOTAL ACCUMULATED IF. PERM ACC. DOSE SW 185 feemp 18. UWUsE D PAR T OF PE RMISSISLE l DOSE Dost freal ACCUMUL A TE D Dost deemt 2 este eeae

INSTRUCTIONS FOR PREPAR ATION OF NHC FORM 5 The preparation and safekeeping of this form or a clear and legible items 9, Self explanatory. The values are to be given in rem.

record containing all the information required on this form is re- 10 and All measurements are to be enterpreted m the best quired purnJant to Section 20.401 of " Standards for Protection 11. method known and in accordance with Paragraph 20.4(c)

Against Radiation," 10 CFR 20, as a current record of occupational Where calculations are made to determme dose, a copy of enternal radiation exposures. Such a record must be maintained such calculations is to be mamtained in conlunction with for each individual for whom personnel monitoring is required - this record. In any case where the dose for a calendar under Section 20.202. Note that a separate NRC Form 5 is to be quarter is less than 10% of the value specified m Paragraph used for recording external exposure to (1) the whole body; 20.101(a), the phrase "less than 10% may be entered in (2) skin of whole body-(3) hands and forearms; or (4) feet and lieu of a numerical value.

ankles, as provided by item 5 below. Item 12. Add the values under 1tems 9,10 and 11 for each twriod Listed below by item are mstructions and additional information of exposure and record the total. In calculating the directly pertment to completing this form. ** Total" any entry "less than 10%" may be disreg,eded.

Item 13. The running total is to be maintained on the taavs of identification calendar quarters. Paragraph 20.3(a) (4) defines calendar quarter. No entry need tw made in this item if only item 1. Self explanatory, item 2. Seif explanatory except that,if indwidual has no social calendar quarter radiation doses are recorded m items 9 security number, the word "none" shall be inses ted. 10,11 and 12, S *P Lifetime Accumulated Done (Whole Body) em ex NOTE: If the licensee chooses to keep the mdividual's Occupational Exposure exposure below that permitted in Paragraph 20.101(alitems item S. **Done to the whole body" shall be deemed to include any 14 through 18 need not be completed. However, en that case dose to the whole body, gonads, active blood-f orming the total whole body dose for each Calendar quarter recorded organs, head and trunk, or kns of eye. Unless the lenses in item 13 (or item 12 of quarterty doses are entered in item of the eyes are protected with eye snields, dose recorded 12) should not exceed 1 1/4 rem.

as whole body dose should include the dose delivered If an individual is exposed under the provisions of Paragraph 20.101 through 4 tissue equivalent absorber having a thickness of (b), complete items 14 through 18 at the enci of each calendar 300 mg,cm2 or less. When the lenses of the *yes are ro- Quat ter and whet) the sfieelis filled. Va6ues an Item 13, when in the y dose middle of a calendar quarter, and values m item 18, must be hrought oa east 7 mg ,d rec d as e a to should include the dose delivered throutp a gissue equivalent nte heor vous totala lated dose from prevous absorber having a thickness of 1,000 mg/cm or less. dose records for the wovdual(e g . from item 16 of NRC Dose recorded as dose to te skin of the whole body, hands f orm 5 or item 11 of NRC Form 4) The total occupatonal and forearms, or feet and ankles should include the dose radiation dose recetved by the mdwidual must be entered delivered through a tissue equivalent absorber having a in this item, including any occupatonal dose received thickness of 7 mg/cm2 or less. The dose to the skm of from sources of radiaton not bcensed by the Commisson the whole body, hands and forearms, or feet and ankles if the indivdual was exposed to sources of radiaton not should be recorded on separate forms unless the dose to hcensed by the Commrsson during any calendar quartes those parts of the body has been included as dose to the af ter completing NRC Form 4 and personnet monitoring whole body on a form ma ntained for recording whole bodV equipment was not wom by the individual. it should be item 6. ThN$ need be completed only when the sheet is used en i eaC c a q" re to record whole body exposures and the licensee is item 15. Enter the total calendar quarter dose from item 13 (or exposmg )the individual 20.101(b which allows upunder the provisions to 3 rems per quarterof toParagraph the from item 12 if quarterly doses are entered in item 12) whole body. Enter in this item the unused part of per- and the date designatmg the end of the calendar quarter missable accumulated dose taken from previous records of in which the dose was received (e.g., March 30,1962).

esposure. i e., item 18 of the preceding NRC Form 5 or item item 16. Add item 14 and item 15 and enter tt'at sum.

13 of NRC Form a if the mdivdual s eiposure cunng item 17. Obtain the Permissible Accumulated Dose (PAD) m rem empioyment with the bcensee beg.ns with this record for the WHOLE BODY. **N" is equal to the number of years of age of the mdevidual on his last birthday. Sut>

l tem 7. Indicate the method used for monitoring the individual's tract 18 from N and muttiply the difference by 5 rem exposure to each type 7f radiation to which he is exposed (e.g., John Smith, age 32;N = 32 PAD = 5(32-18) =

l 1 in the course of his duties. Abbreviations may be used. 70 rem.)

Item 8. Doses received over a period of less than a calendar quarter item 18. Determine the unused part of the PAD by subtract %g need not be separately entered on the form provided that item 16 from item 17. The unused part of the PAD the licensee maintains a current record of the doses received is that portion of the 4 ifetime Accumulated Dose for by the individual which have not as yet been entered on the the individual remaining at the end of the penod form. The period of exposure should specify the day the covered by this sheet.

measurement of that exposure was initiated and the day on which it was terminated. For example if only quarterly doses are entered, the period of exposure Ior the first from calendar quarter of 1962 might be taken as running 0 1962, Monday, and wouldJanuary be indicated 1,1962, through in this Friday, item as March dar,30, Jari.1,1962-i 1962. If weekly doses are entered Monday moming, January 1,1967,a tilm badge issuedand picked up Friday January 5,1962, would be indicated as Jan.1,1962 Jan h, 1962.

PRIVACY ACT ST'ATEMENT i

Pursuant so 5 U S C. 552al*) 131. enacted ero law by ycten 3 01 the Prevecy Act ut 1974 (Pubhc Law 93 579), the fallowing statemeni is furnished to indeveduats who supory miormation to tne Nuclear Aegulatory Commission on NAC Form 5 T' tis informaton is mainiamed e a system of recorcs oes9 area as NAC-27 and oescecea at 40 Federal Regarer 45344 (October 1.19 75L 1 AUTHORITY S*ttrons 53. 63. 65. 81.103.104.161(bl. and 16180) et ttw Atomic E nergy Act of 1954. as ament a (42 U S C 20 73.20S'. euS5,2111. 2133 2134. 220 t(bl. amt 220tio)L The author tv for suhciting the socal security number is 10 CF R Pari 20.

2. PRINCIPAL PURPOSE (Si The miormation es used by the N RC m its evaluation of the risk of radiation asposut* assocat*o .

• t' < licenwd activity and in en erosmg its statutorv vewons bihty to momics and segulate the safety andhealth practices of rtslicenwes. The data permats a encamngtut comparison of both cur rent and long term eaposme emperwnce among types of bcenwes and among hcenwes weihm each tvpe Date on vous *=posure to radiation is available to vou upon vmu request i 3 ROUTINE USES Itw mtormation may be used to prov.de data to other Federal and State agencies invah*d m monitormq and'or evaluating eadiation *=posu re received by individuals emptowed as radiation woehers on a permanent or temporary bases and esposur* received by monetored viuturs. T he mtormatmo may also be dmlused to an appeopriate Federal. State. or tocal agency m the ve ent the mtormation mdecates a violatmn or potential violaton at law and m the course of an arsmm.wahve or pid.ual orou*dmq i

It is voluntar, 4 WHETHER DISCLOSURE IS MANDATORY OR VOLUNTARY AND EFFECT ON INDIVIOU AL OF NOT PROVlulNG INFORMAll0N ina! vou tumisn tne requestec Wormanon eciuomg sooat secueity numteer nowever the hCensee mbst Complete NRC Form 5 on eacn mdividua"De anom personael enoniemma is requerrd under 10 CF R 20 202 Faeture tu do so may subiect the teunse, to enforcement action en accordance with 10 C F R 20 601 The 50041 wcurety number es oised to assme that NRC has an accurate identdier not subl ett to Itw coscodence of simelar names os berthdat*s among ttw large n'imber of persons un who n data is enamtained 5 SYSTEM MANAGERIS) AND ADDRESS Director Ortice ol Management and Program Anarysis U S Nuclear Reguatory Cnmmisson Washmqton. O C 20555

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