23a. MISCELLANEOUS
DOE/NRC FORM 741
(8-2008) Previous editions are obsolete
MANDATORY DATA COLLECTION
AUTHORIZED BY 10 CFR 30, 40, 50, 70, 72, 74, 75, 150,
Public Laws 83-703, 93-438, 95-91
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NUCLEAR MATERIAL TRANSACTION REPORT
Estimated burden per response to comply with this mandatory collection request: 1 hour and 15 minutes. This
information is required for IAEA accounting reports that show changes in inventory of nuclear materials. Send
comments regarding burden estimate to the Records and FOIA Privacy Services Branch (T-5 F53), U.S. Nuclear
Regulatory Commission, Washington, DC 20555-0001, or by internet e-mail to infocollects@nrc.gov, and to the Desk
Officer, Office of Information and Regulatory Affairs, NEOB-10202, (3150-0003), 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.
APPROVED BY OMB: NO. 3150-0003 EXPIRES: 05/31/2011
U.S. DEPARTMENT OF ENERGY
AND
U.S. NUCLEAR REGULATORY COMMISSION
5. PROCESSING CODE 7. DOCUMENTATION (Only if document is classified SECRET)1. SHIPPER'S RIS 2. RECEIVER'S RIS 3. TRANSACTION NO. 4. CORRECTION NO.
a. SHIPPER b. RECEIVER PAGE OF PAGES COPY OF COPIES SERIES
NO. DISTRIBUTION OF COPIES
1
8.a. NAME AND ADDRESS
OF SHIPPER
b. LICENSE
NO.
c. ATTENTION:
d. TELEPHONE:
9.a. NAME AND ADDRESS
OF RECEIVE
b. LICENSE
NO.
c. ATTENTION:
d. TELEPHONE:
10. NO OF DATA LINES 11. NATURE OF TRANSACTION
12.a. SHIPPED FOR ACCOUNT OF
b. RIS
13.a. SHIPPED TO ACCOUNT OF
b. RIS
2
3
4
5
6
7
8
9
15. EXPORT OR IMPORT TRANSFERS: LICENSE NO.
14. TRANSFER AUTHORITY - CONTRACT, NM DRAFT, OR ORDER NUMBER
17.
LINE
NUMBER
b. SHIPPER'S CORRECTION
c. RECEIPT
d. RECEIVER'S MEASUREMENT
e. RECEIVER'S CORRECTION
a. SHIPMENT
MONTH
(MM)
DAY
(DD)
YEAR
(YYYY)
24. TOTAL GROSS WEIGHT 25. TOTAL VOLUME
(Waste Transfers Only)
16. MATERIAL TYPE AND DESCRIPTION
b. CONCISE NOTE ATTACHED
c. UK REPORTABLE?
YES NO
BACK
REFERENCE
NUMBER
a.
TYPE
OF INV.
CHANGE
c.
IDENTIFICATION
(ITEM/BATCH NAME)
d.
NO. OF
ITEMS
e.
PROJECT
NUMBER
f.
MATE-
RIAL
TYPE
g.
COMP/
FACILITY
CODE
h.
OWNER
CODE
i.
KEY
MEAS.
POINT
j.
1
BASIS
MEAS. IDENT.
k.
2
OMP
3
METHOD
GROSS WEIGHT
l.
NET WEIGHT
m.
ELEMENT
WEIGHT
n.
ELEMENT
LIMIT OF
ERROR
o.
WEIGHT %
ISOTOPE
p.
ISOTOPE
WEIGHT
q.
ISOTOPE
LIMIT OF
ERROR
r.
26. SHIPPER'S DATA
26s. SHIPPER'S DATA
SIGNATURE OF AUTHORIZED OFFICIAL AND DATE SIGNED
27s. RECEIVER'S DATA
SIGNATURE OF AUTHORIZED OFFICIAL AND DATE SIGNED
27. RECEIVER'S DATA
WARNING:
FALSE STATEMENTS IN THIS CERTIFICATE MAY BE SUBJECT TO CIVIL AND/OR CRIMINAL PENALTIES. NRC REGULATIONS REQUIRE THAT SUBMISSIONS TO THE NRC
BE COMPLETE AND ACCURATE IN ALL MATERIAL RESPECTS. 18 U.S.C. SECTION 1001 MAKES IT A CRIMINAL OFFENSE TO MAKE A WILLFULLY FALSE STATEMENT OR
REPRESENTATION TO ANY DEPARTMENT OR AGENCY OF THE UNITED STATES AS TO ANY MATTER WITHIN ITS JURISDICTION.
18.
COUNTRY OF
OBLIGATION
19.
MATERIAL
TYPE
20.
OBLIGATED
ELEMENT WEIGHT
21.
OBLIGATED ISOTOPE
WEIGHT
For Enriched Uranium Only
22. ACTION DATE
LINE
NO.
b.
6. ACTION CODE
a. SHIPPER b. RECEIVER
PRINTED ON RECYCLED PAPERDOE/NRC FORM 741 (8-2008)
