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The U.S. Nuclear Regulatory Commission is in the process of rescinding or revising guidance and policies posted on this webpage in accordance with Executive Order 14151 Ending Radical and Wasteful Government DEI Programs and Preferencing, and Executive Order 14168 Defending Women From Gender Ideology Extremism and Restoring Biological Truth to the Federal Government. In the interim, any previously issued diversity, equity, inclusion, or gender-related guidance on this webpage should be considered rescinded that is inconsistent with these Executive Orders.

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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:

Bernard Litkett, Reactor Engineer (Examiner Qualified)

NRR/DRO/IOLB

(301)415-3657 or Bernard.Litkett@nrc.gov

 

Page Last Reviewed/Updated Tuesday, September 17, 2024