Alert

Due to a lapse in appropriations, the NRC has ceased normal operations. However, excepted and exempted activities necessary to maintain critical health and safety functions—as well as essential progress on designated critical activities, including those specified in Executive Order 14300—will continue, consistent with the OMB-Approved NRC Lapse Plan.

NRC Form 5 – Occupational Dose Record for a Monitoring Period

Form Number:	NRC Form 5
Form Title:	Occupational Dose Record for a Monitoring Period
Current Edition:	11-18-2024
Authority Directive or Regulation:	10 CFR Part 20
Form Status:	Approved by OMB: 3150-0006, Expires: 11/30/2024
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 Wednesday, November 20, 2024