NRC Form 396 – Certification of Medical Examination by Facility Licensee
| Form Number: | NRC Form 396 |
|---|---|
| Form Title: | Certification of Medical Examination by Facility Licensee |
| Current Edition: | 09-11-2024 |
| Authority Directive or Regulation: | 10 CFR 55.21, 55.23, 55.25, 55.27, 55.31, 55.33, 55.53 and 55.57 |
| Form Status: | Approved by OMB: 3150-0024, Expires: 12-31-2025 Changes to this revision of the form include addition of date of birth and email address, correction of editorial errors, and updated NRC addresses. |
| Special Instructions: |
Instructions are provided with the form. NRC Form 396, Certification of Medical Examination by Facility Licensee, must accompany the NRC Form 398 unless a waiver of the medical examination is being requested. For questions, please call or e-mail: Rebecca Riggs, Reactor Engineer (Examiner Qualified)
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Page Last Reviewed/Updated Wednesday, July 30, 2025
Page Last Reviewed/Updated Wednesday, July 30, 2025