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Nuclear Regulatory Commission – NRC

NRC Forms

Form

Title of Form

3

Notice to Employees

3A

Aviso a los Empleados

4

Cumulative Occupational Dose History

5

Occupational Dose Record for a Monitoring Period

7

Application for NRC Export/Import License, Amendment, or Renewal

64

Travel Voucher

136

Security Termination Statement

176

A. Security Acknowledgment
B. Special Nuclear Material Access Authorization Acknowledgment

189

DOE Laboratory Project and Cost Proposal for NRC Work

212

Qualifications Investigation (Technical Positions)

212A

Qualifications Investigations (Secretarial/Clerical)

237

Request for Access Authorization

241

Report of Proposed Activities in Non-Agreement States, Areas of Exclusive Federal Jurisdiction, or Offshore Waters

244

Registration Certificate – Use of Depleted Uranium under General License

277

Request for Visit

313

Application for Materials License

313A(amp)

Authorized Medical Physicist Training and Experience And Preceptor Attestation

313A(anp)

Authorized Nuclear Pharmacist Training and Experience and Preceptor Attestation

313A(aud)

Authorized User Training and Experience And Preceptor Attestation

313A(aus)

Authorized User Training and Experience And Preceptor Attestation

313A(aut)

Authorized User Training and Experience And Preceptor Attestation

313A(rso)

Radiation Safety Officer Training and Experience And Preceptor Attestation

314

Certificate of Disposition of Materials

327

Special Nuclear Material (SNM) and Source Material (SM) Physical Inventory Summary Report

335

Bibliographic Data Sheet

354

Data Report on Spouse

361

Reactor Plant Event Notification Worksheet

361A

Fuel Cycle and Materials Event Notification Worksheet

361C

Gaseous Diffusion Plant Event Notification Worksheet

366

Licensee Event Report (LER)

366A

Licensee Event Report (LER) [Continuation]

366B

Licensee Event Report Failure [Continuation]

390A

Release to Publish Unclassified NRC Contractor Speeches, Papers, and Journal Articles

396

Certification of Medical Examination by Facility Licensee (with instructions)

396

Certification of Medical Examination by Facility Licensee (without instructions)

398

Personal Qualification Statement – Licensee

426

Authorization to Publish a Manuscript in the NUREG Series

445

Request for Approval of Official Foreign Travel

450

General Assignment

483

Registration Certificate – in vitro Testing with Byproduct Material Under General License

526

Certification of Small Entity Status for the Purposes of Annual Fees Imposed under 10 CFR Part 171

531

Request for Taxpayer Identification Number

536

Operator Licensing Examination Data

540

Low Level Waste Manifest
Shipping Paper

540A

Low Level Waste Manifest
Shipping Paper (Continuation)

541

Low Level Waste Manifest
Container and Waste Description

541A

Low Level Waste Manifest
Container and Waste Description (Continuation)

542

Low Level Waste Manifest
Index and Regional Compact Tabulation

542A

Low Level Waste Manifest
Index and Regional Compact Tabulation (Continuation)

552A

Status Report Review

554B

Independent Government Cost Estimate (IGCE) for Interagency Agreements

555A

Summary of Negotiations
Interagency Agreement

556A

Fiscal Year Advance Procurement Plan Interagency Agreement

558A

Summary of Proposal Evaluation
Interagency Agreement

559A

NRC/Interagency Project Closeout

590

Application/Permit for Use of the Two White Flint North (TWFN) Auditorium

629

Authorization for Payment by Credit Card

653

Transfers of Industrial Devices Report

662

Award of Interagency Agreement

664

General Licensee Registration

667

Servicing Agency Project and Cost Proposal for NRC Work

740M

Concise Note

741

Nuclear Material Transaction Report

742

Material Status Report

742C

Physical Inventory Listing

748

National Source Tracking Transaction Report

790

Classification Record

IAEA Forms

Form

Title of Form

IAEA – N71IAEA Design Information Questionnaire
All Facilities
IAEA – N72IAEA Design Information Questionnaire
Research and Power Reactors
IAEA – N73IAEA Design Information Questionnaire
Conversion and/or Fuel Fabrication Plants
IAEA – N74IAEA Design Information Questionnaire
Reprocessing Plants
IAEA – N75IAEA Design Information Questionnaire
Isotopic Enrichment Plants
IAEA – N91IAEA Design Information Questionnaire
Information in Respect of Nuclear Material Outside Facilities
IAEA – N92IAEA Design Information Questionnaire
Research and Development Facilities
(Locations of Nuclear Material in Amounts Greater Than One Effective Kilogram)
IAEA – N93IAEA Design Information Questionnaire
Critical (Sub-Critical) Facilities
IAEA – N94IAEA Design Information Questionnaire
Separate Storage Installations

Standard and Optional Forms

Form

Title of Form

SF312Classified Information Nondisclosure Agreement

Inside Nuclear Regulatory Commission – NRC