Fillable Printable Application for NRC Export or Import License, Amendment, Renewal, or Consent Request(s)
Fillable Printable Application for NRC Export or Import License, Amendment, Renewal, or Consent Request(s)
Application for NRC Export or Import License, Amendment, Renewal, or Consent Request(s)
NRC FORM 7
(11-2012)
10 CFR 110
U. S. NUCLEAR REGULATORY COMMISSION
APPROVED BY OMB: NO. 3150-0027
EXPIRES: (11/30/2015)
Page 1 of
PART A. FOR NRC USE ONLY OR
PUBLIC NON-PUBLIC
DATE RECEIVED
LICENSE NUMBER DOCKET NUMBER
ADAMS ACCESSION NUMBER
PART B. TO BE COMPLETED FOR ALL LICENSES, AMENDMENTS, RENEWALS, OR CONSENT REQUESTS
(If more space is needed to complete any of the items, use Pages 3-4 first, and then attach additional sheets, if necessary.)
1. NAME AND ADDRESS OF APPLICANT/LICENSEE
1a. NAME OF APPLICANT'S CONTACT
1b. APPLICANT'S REFERENCE NUMBER
1c. PHONE NUMBER 1d. FAX NUMBER
1e. E-MAIL ADDRESS
2. TYPE OF ACTION REQUESTED (Check One)
3. CONTRACT NUMBER(S) 4. FIRST SHIPMENT DATE 5. LAST SHIPMENT DATE 6. PROPOSED EXPIRATION DATE
PART C. TO BE COMPLETED FOR EXPORT LICENSES, AMENDMENTS, OR RENEWALS
(If more space is needed to complete any of the items, use Pages 3-4 first, and then attach additional sheets, if necessary.)
7. NAME(S) / ADDRESS(ES) OF SUPPLIERS
AND/OR OTHER PARTIES TO THE EXPORT
7a. FUNCTION(S) PERFORMED/SERVICE(S) PROVIDED
8. NAME(S) / ADDRESS(ES) OF INTERMEDIATE
FOREIGN CONSIGNEE(S)
8a. INTERMEDIATE USE(S)
9. NAME(S) / ADDRESS(ES) OF ULTIMATE
FOREIGN CONSIGNEE(S)
9a. ULTIMATE END USE(S)
10. DESCRIPTION OF RADIOACTIVE MATERIALS, SEALED SOURCES,
NUCLEAR FACILITIES, EQUIPMENT, OR COMPONENTS; FOR
NUCLEAR EQUIPMENT INCLUDE TOTAL DOLLAR VALUE OF
EQUIPMENT FOR EXPORT
10a. MAX TOTAL VOLUME /
ELEMENT WGT (KG), OR
TOTAL ACTIVITY (TBq)
10b. MAX ENRICHMENT
OR WGT %
10c. MAX ISOTOPE
WGT (KG)
11. FOREIGN OBLIGATIONS (BY COUNTRY AND BY PERCENTAGE OF MAXIMUM TOTAL VOLUME)
NRC FORM 7 (11-2012)
APPLICATION FOR NRC EXPORT OR IMPORT
LICENSE, AMENDMENT, RENEWAL,
OR CONSENT REQUEST(S)
(See Instructions on Pages 4 and 5)
Estimated burden per response to comply with this mandatory collection request: 2.4 hours. This
submittal is reviewed to ensure that the applicable statutory, regulatory, and policy
considerations are satisfied. Send comments regarding burden estimate to the Information
Services Branch (T-5 F53), U.S. Nuclear Regulatory Commission, Washington, DC 20555-0001,
Information and Regulatory Affairs, NEOB-10202, (3150-0027), Office of Management and
Budget, Washington, DC 20503. If a means used to impose an information collection does not
display a currently valid OMB control number, the NRC may not conduct or sponsor, and a
person is not required to respond to, the information collection.
EXPORT
(Parts B, C, E)
IMPORT
(Parts B, D, E)
AMENDMENT/RENEWAL
Current License Number:
CONSENT REQUEST
(Parts B, C)
Current License Number:
U. S. NUCLEAR REGULATORY COMMISSIONNRC FORM 7
(11-2012)
10 CFR 110
APPLICATION FOR NRC EXPORT OR IMPORT
LICENSE, AMENDMENT, RENEWAL, OR CONSENT REQUEST(S) (Continued)
Page 2 of
LICENSE NUMBER
DOCKET NUMBER
OR
PUBLIC NON-PUBLIC
PART D. TO BE COMPLETED FOR IMPORT LICENSES, AMENDMENTS, OR RENEWALS
(If more space is needed to complete any of the items, use Pages 3-4 first, and then attach additional sheets, if necessary.)
12. NAME(S) / ADDRESS(ES) OF FOREIGN
SUPPLIERS AND/OR OTHER PARTIES
TO IMPORT
12a. NRC EXPORT LICENSE NUMBER(S)
(if applicable)
13. NAME(S) / ADDRESS(ES) OF INTERMEDIATE
CONSIGNEE(S)
13a. LICENSE NUMBER(S) / EXPIRATION DATE(S)
13b. INTERMEDIATE USE(S)
14. NAME(S) / ADDRESS(ES) OF ULTIMATE U. S.
CONSIGNEE(S)
14a. LICENSE NUMBER(S) / EXPIRATION DATE(S)
14b. ULTIMATE END USE(S)
15. DESCRIPTION OF RADIOACTIVE MATERIALS, SEALED SOURCES,
NUCLEAR FACILITIES
15a. MAX TOTAL VOLUME /
ELEMENT WGT (KG), OR
TOTAL ACTIVITY (TBq)
15b. MAX ENRICHMENT
OR WGT %
15c. MAX ISOTOPE
WGT (KG)
16. FOREIGN OBLIGATIONS (BY COUNTRY AND BY PERCENTAGE OF MAXIMUM TOTAL VOLUME)
17. ADDITIONAL INFORMATION
PROVIDED ON PAGES 3, 4,
AND/OR ON SEPARATE SHEETS?
17a. COPIES OF RECIPIENTS'
AUTHORIZATIONS PROVIDED?
YES NO
YES NO
18. CERTIFICATION:
I, the applicant's authorized official, hereby certify that this application is prepared in conformity
with Title10, Code of Federal Regulations, and that all information provided is correct to the best
of my knowledge.
18a. PRINT NAME AND TITLE OF AUTHORIZED OFFICIAL
18b. SIGNATURE -- AUTHORIZED OFFICIAL
18c. DATE
PART E. TO BE COMPLETED FOR ALL LICENSES, AMENDMENTS, RENEWALS OR CONSENT REQUEST(S)
ADAMS ACCESSION NUMBER
NRC FORM 7 (11-2012)
U. S. NUCLEAR REGULATORY COMMISSIONNRC FORM 7
(11-2012)
10 CFR 110
Page
LICENSE NUMBER
DOCKET NUMBER
ADAMS ACCESSION NUMBER
OR
PUBLIC NON-PUBLIC
ADDITIONAL INFORMATION (Reference applicable block numbers from page 1 and/or page 2 for each entry)
of
APPLICATION FOR NRC EXPORT OR IMPORT
LICENSE, AMENDMENT, RENEWAL, OR CONSENT REQUEST(S) (Continued)
NRC FORM 7 (11-2012)
General Instructions: A completed, signed original NRC Form 7 may be mailed to the Deputy Director, Office of International
Programs, U.S. Nuclear Regulatory Commission, Washington, DC 20555-0001, or hand-delivered to the Deputy Director at 11555
Rockville Pike, Rockville, Maryland 20852.
Refer to Title 10 of the Code of Federal Regulations, Part 110, for specific NRC export/import licensing requirements. For each
license, amendment or renewal application, identify all foreign and domestic locations where exports or imports will be handled,
sorted, repackaged and/or processed in any way. Provide information on quantities, forms, and other characteristics of the
radioactive materials, sealed sources, nuclear facilities and equipment to be exported or imported and indicate how they will be
used by each of the parties listed. If more space is needed to complete any of the items on this form, use the continuation pages
first, and then attach additional sheets. Reference appropriate BLOCK number(s) for each entry on all additional sheets. All
applicants should avoid submitting proprietary information unless absolutely necessary, as NRC is required to make copies of all
applications received available to the public. If proprietary information must be submitted, follow procedures in 10 CFR 2.390,
otherwise, such information could be publicly disclosed and/or processing of an application could be significantly delayed.
U. S. NUCLEAR REGULATORY COMMISSION
INSTRUCTIONS FOR PREPARATION OF NRC FORM 7, APPLICATION FOR
NRC EXPORT OR IMPORT LICENSE, AMENDMENT, RENEWAL OR CONSENT REQUEST(S)
BLOCK 1. Enter name and complete physical address of the
corporation or other entity with direct control over distribution
of proposed export(s) or import(s), and where required
records will be maintained and can be inspected. Post Office
Box Numbers or names of divisions or departments within a
legal entity are NOT acceptable entries for this BLOCK.
BLOCKS 1a-e. Provide name and contact information
identifying the best party to answer questions about an
application. Applicants should use BLOCK 1b to assign their
own reference number to identify application documents.
BLOCK 2. Indicate the TYPE OF NRC LICENSING ACTION
requested by checking:
- AMENDMENT OR RENEWAL if applying to modify or
extend an export or import license previously issued by NRC
(and not yet expired). Include NRC license number in space
provided. If NRC receives an amendment/ renewal application
at least 30 days or more before the license expires, its terms
will remain valid and, if circumstances permit, it can continue
to be used until NRC completes action on the amendment or
renewal application.
-CONSENT REQUEST if submitting a request for the NRC to
obtain government-to-government consent to authorize
shipment(s) of Category 1 quantities of byproduct material.
Include NRC license number in space provided.
BLOCK 4. Enter the anticipated date of the first shipment
(MM/DD/YYYY).
PART C. TO BE COMPLETED BY APPLICANTS FOR
EXPORT LICENSES, AMENDMENTS, RENEWALS,
OR CONSENTS
BLOCK 7. Enter names of supplier(s) and other parties to
export not listed in BLOCKS 1, 8, OR 9. Provide complete
physical address(es) where correspondence should be sent
and where export(s) can be inspected. Post Office Box
Numbers are NOT acceptable entries for this BLOCK.
BLOCK 7a. Describe functions to be performed and/or
services to be provided by any parties listed in BLOCK 7.
BLOCKS 8-9. Enter names and physical address(es) for each
intermediate and each ultimate foreign location. Post Office
Box Numbers are NOT acceptable entries for these BLOCKS.
BLOCKS 8a and 9a. Describe how each consignee will use
export(s), including functions to be performed and/or services
to be provided.
BLOCK 10. Describe key characteristics including physical
and chemical forms, etc., of radioactive materials (i.e., source,
special nuclear or byproduct materials including sealed
sources or devices and radioactive waste), nuclear facilities
uranium, or thorium, and provide chemical form (e.g., U3O8,
Th-227). Identify and provide total volume in kilograms of ores
containing 0.05% or more of source material (e.g., tantalum,
niobium) and specify source material contained. Identify
special nuclear material as plutonium, high enriched uranium
(> 20% U-235) or low enriched uranium (<20% U-235) and
specify chemical form.
NOTE: FOR CONSENTS FILL OUT BLOCKS,
(1a-e,2,8,9,10,10a,17,18)
PART A. FOR NRC USE ONLY
PART B. TO BE COMPLETED BY ALL APPLICANTS FOR
ALL LICENSES, AMENDMENTS, RENEWALS, OR
CONSENT REQUEST(S)
NOTE: For amendments and renewals, provide only the new
or changed information, as appropriate, in PART C and/or
PART D. (For example, enter names and addresses of parties
or consignees, only if they need to be added to, deleted from,
or their information needs to be changed. If seeking to
increase the volume or quantity of material or equipment,
specify the additional increment, and, if applicable, indicate
what the new, combined cumulative total will be.)
- IMPORT if applying for a new import license.
- EXPORT if applying for a new export license.
BLOCK 3. If known, provide contract number(s), which may
be useful references for example, if reviewers need to contact
recipients or other parties listed on the application.
BLOCK 6. Enter a proposed license expiration date
(MM/DD/YYYY), to accommodate export activities. Note that
NRC licenses are typically issued for 1-5 years.
BLOCK 5. Enter the anticipated date of last shipment
(MM/DD/YYYY).
An application for a specific license to export or import or a request for an exemption from a licensing requirement must be
accompanied by the appropriate fee in accordance with 10 CFR Part 170. The fee schedules are provided in §§ 170.21 and
170.31. The reference “IMEX” should be included on your form of payment. A license application will not be processed unless the
specified fee is received.
BLOCK 15. Describe key characteristics including physical
and chemical forms, etc., of radioactive materials (i.e., source,
special nuclear or byproduct materials including sealed
sources or devices and radioactive waste), and nuclear
facilities. For radioactive waste, identify and provide maximum
total volume in kilograms for each non-radioactive material
(e.g., contaminated steel) involved, and physical and chemical
forms for each radioactive source, special nuclear or
byproduct material. Provide overall waste classification (see
10 CFR 61.55) if imported for direct disposal at a Part 61 or
equivalent Agreement State licensed facility; responsible
industrial process, route(s) of transit, and the status of
arrangements for disposition in the U.S., e.g., any agreement
by a low-level waste compact or State to accept for
management or disposal. For nuclear facilities, provide total
quantities; types; names, design power or annual capacity
rating; and the estimated combined total dollar value.
BLOCK 15a. For source and/or special nuclear material,
provide maximum total volume/element weight over license
life in kilograms. For Appendix L byproduct material, including
that which is in the form of radioactive waste, provide
maximum total activity over license life in TBq.
BLOCKS 15b-c. For special nuclear material including that
which is in the form of radioactive waste, provide maximum
enrichment/weight % and maximum total isotope weight over
license life in kilograms.
BLOCK 16. Identify each country and the percentage of the
maximum total volume that may be obligated to them (require
U. S. Government action, e.g., prior notification).
PART E. TO BE COMPLETED BY ALL APPLICANTS
BLOCK 17. Check YES or NO to verify whether or not
additional information is being provided using the space
provided on the continuation pages and separate sheets.
BLOCK 17a. Check YES or NO to verify whether or not
copies of domestic recipients' authorizations required for
Appendix P materials (see Part 110.32 requirements) are
included with the application.
BLOCKS 18a-c. An authorized official of the legal entity
applying for the License, Amendment or Renewal, must certify
Identify Appendix L byproduct materials by name and form,
including maximum total activities and types of sealed
sources and/or devices to be exported over the license life.
Identify Appendix P materials by name and form, including
maximum total quantities(activity in TBq) and types of sealed
sources and/or devices to be exported on a per shipment basis.
For radioactive waste, identify and provide maximum total
volume in kilograms for each non-radioactive material involved,
and physical and chemical forms for each radioactive material,
along with the overall waste classification (see 10 CFR 61.55)
if exported for the purposes of disposal in a land disposal
facility as defined in 10 CFR Part 61, a disposal area as
defined in Appendix A to 10 CFR Part 40, or an equivalent
facility; route(s) of transit, forms of management and ultimate
disposition. For nuclear facilities, provide total quantity; types;
names, design power or annual capacity rating; and the
estimated combined total dollar value. For nuclear equipment,
identify all items by name, total quantity and function and
provide the estimated combined total dollar value.
BLOCK 10a. For source material, provide maximum total
volume/element weight over license life in kilograms. For
special nuclear material, provide maximum total element
weight over license life in kilograms. For each Appendix L
byproduct material listed, provide maximum total activity over
license life in Terabequerels (TBq). For each Appendix P
material listed, provide maximum total activity per shipment in
Tbq.
BLOCKS 10b-c. For special nuclear material including as
radioactive waste, provide maximum weight % (enrichment)
and total isotope weight over license life in kilograms.
BLOCK 11. Identify each country and the percentage of the
maximum total volume that may be obligated to them
(requires U. S. Government action, e.g., prior notification).
PART D. TO BE COMPLETED BY APPLICANTS FOR
IMPORT LICENSES, AMENDMENTS OR RENEWALS
BLOCK 12. Enter name(s) and address(es) of foreign
supplier(s) or exporter(s).
BLOCKS 13a and 14a. Enter NRC or Agreement State
Materials License number(s) including expiration date(s)
(MM/DD/YYYY) for each U.S. consignee, authorizing receipt,
possession, use or distribution.
U. S. NUCLEAR REGULATORY COMMISSION
INSTRUCTIONS FOR PREPARATION OF NRC FORM 7, APPLICATION FOR
NRC EXPORT OR IMPORT LICENSE, AMENDMENT, RENEWAL OR CONSENT REQUEST(S) CONTINUED
BLOCK 12a. For import(s) originally exported under a specific
NRC license, enter that license number.
