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:	06-2022
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: 09/30/2022
Special Instructions:	Instructions are on Page 1 and Page 3 of 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: Bernard Litkett, Reactor Engineer (Examiner Qualified), NRR/DRO/IOLB (301) 415-3657 or Bernard.Litkett@nrc.gov

Page Last Reviewed/Updated Friday, June 03, 2022