Alert

The NRC is shutdown due to the lapse in appropriations. Exempted activities to maintain critical health and safety activities and progress on critical activities, including activities outlined in Executive Order 14300, as described in the OMB Approved NRC Lapse Plan will continue.

NRC Form 4 – Cumulative Occupational Dose History

Form Number:	NRC Form 4
Form Title:	Cumulative Occupational Dose History
Current Edition:	11-04-2024
Authority Directive or Regulation:	10 CFR Part 20
Form Status:	Approved by OMB: 3150-0005, Expires: 07/31/2027
Special Instructions:	Instructions and additional information pertinent to the completion of this form are on Page 2 of the form. For Questions: E-mail: Terry.Brock@nrc.gov RES/DSA/RPB Senior Health Physicist Telephone Number: (301) 415-1793

Page Last Reviewed/Updated Tuesday, November 19, 2024