Get Nrc Form 396 2021-2025

NRC Form 396 is essential for certifying the medical examination of facility licensees by the U.S. Nuclear Regulatory Commission. This guide provides a clear, step-by-step approach to successfully complete this form online, ensuring users understand each component.

Follow the steps to complete the NRC Form 396 online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the applicant's full name as it appears on NRC Form 398. Include the applicant's suffix and docket number to ensure accurate identification.
3. Provide the facility's name and corresponding facility docket number. If there are multiple docket numbers, separate them using a semicolon.
4. Enter the full address of the applicant or operator, making sure all details are accurately filled to avoid delays in processing.
5. Complete the section related to the date of the most recent biennial examination, ensuring the format is MM/DD/YYYY.
6. In Section A, fill out the medical exam information by providing the physician's printed name, certification date, license number, and state. Select the appropriate ANSI guidance document used for the medical assessment.
7. Indicate any required restrictions or conditions for the applicant/operator by checking the relevant boxes and ensuring to add explanations and supporting medical evidence as required.
8. Sign and date the application in Section B, confirming the accuracy of the information provided.
9. Complete Section C by having a senior management representative certify the document under penalty of perjury. This includes adding their printed name, title, signature, and date.
10. After finishing all sections, review the form for completeness and accuracy. Users can then save changes, download, print, or share the completed form as necessary.

Complete your NRC Form 396 online now for a smooth submission process.