Form NRC Form 7 NRC Form 7 Application for NRC Export/Import License Amendment or R

Page 1 of
NRC FORM 7

U. S. NUCLEAR REGULATORY COMMISSION

(MM-DD-YYYY)
10 CFR 110

APPROVED BY OMB: NO. 3150-0027

APPLICATION FOR NRC EXPORT OR
IMPORT LICENSE, AMENDMENT,
RENEWAL, OR CONSENT REQUEST(S)
(See Instructions on Pages 4 and 5)

PART A. FOR NRC USE ONLY
License Number

Public

EXPIRES: (MM/DD/YYYY)

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 FOIA, Library, and Information Collections Branch (T-6 A10M), U.S.
Nuclear Regulatory Commission, Washington, DC 20555-0001, or by email to Infocollects.Resource@nrc.gov,
and the OMB reviewer at: OMB Office of Information and Regulatory Affairs, (3150-0027), Attn: Desk Officer for
the Nuclear Regulatory Commission, 725 17th Street NW, Washington, DC 20503. The NRC may not conduct or
sponsor, and a person is not required to respond to, a collection of information unless the document requesting
or requiring the collection displays a currently valid OMB control number.

OR

Non-Public

Docket Number

Date Received
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. Office Telephone Number

1d. Office Facsimile Telephone Number

1e. Applicant's Email Address
2. Type of Action Requested

Export (Parts B, C, E)

Amendment/Renewal

Current License Number:

Import (Parts B, D, E)

Consent Request (Parts B, C)

Current License Number:

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 U. S. Suppliers and/or
other U. S. Parties to the Export

8. Name(s)/Address(es) of Intermediate
Foreign Consignee(s)

9. Name(s)/Address(es) of Ultimate Foreign
Consignee(s)

7a. Function(s) Performed/Service(s) Provided

8a. Intermediate Use(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. Maximum Total Volume/
Element WGT (KG), or
Total Activity (TBq)

10b. Max Enrichment
or WGT%

11. Foreign origin or obligations by country and, if known, by percentage of maximum total volume (leave blank for byproduct licenses)

NRC FORM 7 (MM-DD-YYYY)

10c. Max Isotope
WGT (KG)

Page 2 of
NRC FORM 7

U. S. NUCLEAR REGULATORY COMMISSION

(MM-DD-YYYY)
10 CFR 110

APPLICATION FOR NRC EXPORT OR IMPORT
LICENSE, AMENDMENT, RENEWAL, OR CONSENT REQUEST(S) (Continued)

License Number

Docket Number

Adams Accession Number

Public

OR

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 Foreign Parties to Import

13. Name(s)/Address(es) of Foreign or U. S.
Intermediate Consignee(s)

14. Name(s)/Address(es) of Ultimate
U. S. Consignee(s)

12a. NRC Export License Number(s) (if applicable)

13a. License Number(s) / Expiration Date(s)

14a. License Number(s) / Expiration Date(s)

13b. Intermediate Use(s)

14b. Ultimate End Use(s)

15. Description of Radioactive Materials, Sealed Sources, Nuclear Facilities

15a. Maximum 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)

PART E. TO BE COMPLETED FOR ALL LICENSES, AMENDMENTS, RENEWALS OR CONSENT REQUEST(S)
(If more space is needed to complete any of the items, use Pages 3-4 first, and then attach additional sheets, if necessary.)

17. Additional Information provided on pages 3, 4, and/or separate sheets?
Yes

17a. Copies of Recipient's Authorizations Provided?

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

NRC FORM 7 (MM-DD-YYYY)

18b. Signature -- Authorized Official

18c. Date

Page 3 of
NRC FORM 7

(MM-DD-YYYY)
10 CFR 110

License Number

U. S. NUCLEAR REGULATORY COMMISSION

APPLICATION FOR NRC EXPORT OR IMPORT
LICENSE, AMENDMENT, RENEWAL, OR CONSENT REQUEST(S) (Continued)
Docket Number

Adams Accession Number

Additional Information (Reference applicable block numbers from page 1 and/or page 2 for each entry)

NRC FORM 7 (MM-DD-YYYY)

Public

OR

Non-Public

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)
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, hand-delivered to the Deputy Director at 11555 Rockville Pike,
Rockville, Maryland 20852, or emailed to NRCForm7.@nrc.gov.
Submitting an electronic signature: An authorized official of the legal entity applying for the License, Amendment or Renewal, must
certify the application using an electronic signature such as Adobe Acrobat e-sign. The signed document should then be submitted to
the NRC using the email address shown above.
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, and request for exemption 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.
NOTE: FOR CONSENTS FILL OUT BLOCKS,
(1a-,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)
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:
- EXPORT if applying for a new export license.
- IMPORT if applying for a new import license.
- 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 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 4. Enter the anticipated date of the first shipment
(MM/DD/YYYY).
BLOCK 5. Enter the anticipated date of last shipment
(MM/DD/YYYY).
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.
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.)
PART C. TO BE COMPLETED BY APPLICANTS FOR EXPORT
LICENSES, AMENDMENTS, RENEWALS, OR CONSENTS
BLOCK 7. Enter names of U. S. supplier(s) and other U. S.
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.
NOTE: U. S. transport/shipping service provider and/or
commercial carrier; do not need to be listed as "Other" U. S.
Parties on the application. These entities are not parties-ininterest to an export license. They serve only as transporters of
the nuclear material or commodity being exported and their legal
responsibility from a regulatory standpoint is limited to complying
with NRC's and the Department of Transportation's transportation
requirements. If applicants list transport/shipping service
providers or commercial carriers on their applications, they can
be identified on the export license if issued, but that does not
convert them into legally responsible formal parties-in-interest to
the license. Carriers are not relevant to the NRC's review of an
export application to determine whether the statutory
nonproliferation criteria have been met.
BLOCK 7a. Describe functions to be performed and/or services
to be provided by any U. S. parties listed in BLOCK 7.

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)
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.

BLOCK 12a. For import(s) originally exported under a specific
NRC license, enter that license number.

BLOCKS 8a and 9a. Describe how each consignee will use
export(s), including functions to be performed and/or services to be
provided.

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.

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, or equipment, 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 (e.g. UF6, U02).
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 Terabecquerels (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, physical and chemical
forms for each radioactive material, 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. For proposed exports or imports (of source or special
nuclear material or nuclear facilities or equipment). Identify each
country of origin of equipment or materials, and any other countries
that have processed the material prior to its import into the United
States, and, if known, the percentage of the maximum total volume
that may be obligated to a foreign country (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).

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 for each radioactive material contained,
including its physical and chemical forms for each radioactive
source, special nuclear or byproduct material. Identify
responsible, and provide industrial process, route(s) of transit, as
well as 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.