Form 742 Material Balance Report

Form 742 or the "Material Balance Report" is a form issued by the U.S. Department of Energy.

Download a fillable PDF version of the Form 742 down below or find it on the U.S. Department of Energy Forms website.

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DOE/NRC FORM 742
U.S. DEPARTMENT OF ENERGY
APPROVED BY OMB: NO. 3150-0004
EXPIRES: 04/30/2021
(04-2018)
Estimated burden per response to comply with this mandatory collection request: 2 hours for
AND
MANDATORY DATA
small licensees and 5 hours for large licensees. Reported lessons learned are incorporated
U.S. NUCLEAR REGULATORY COMMISSION
COLLECTION
into the licensing process and fed back to industry. Send comments regarding burden
AUTHORIZED BY
estimate to the Information Services Branch (T-2 F43), U.S. Nuclear Regulatory
10 CFR 30, 40, 50, 70, 72,
Commission, Washington, DC 20555-0001, or by e-mail to Infocollects.Resource@nrc.gov,
74, 75, 150, Public Laws
83-703, 93-438, 95-91
and to the Desk Officer, Office of Information and Regulatory Affairs, NEOB-10202,
MATERIAL BALANCE REPORT
(3150-0004), 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.
1. NAME AND ADDRESS
2. LICENSE NUMBER(S)
3. REPORTING IDENTIFICATION
SYMBOL (RIS)
5. MATERIAL TYPE
4. REPORT PERIOD (MM/DD/YYYY)
(Submit separate report for each type)
FROM
TO
SECTION A
MATERIAL ACCOUNTABILITY
PC
SEQ
A. ELEMENT WEIGHT B. ISOTOPE WEIGHT
8. BEGINNING INVENTORY -- U.S. GOVT-OWNED
9. BEGINNING INVENTORY -- NOT U.S. GOVT-OWNED
RECEIPTS
11. PROCUREMENT FROM DOE
RIS
FROM:
13. PROCUREMENT -- FOR THE ACCOUNT OF DOE
14. DOD RETURNS -- USE A
15. DOD RETURNS -- USE B
16. DOD RETURNS -- OTHER USES
21. PRODUCTION
22. FROM OTHER MATERIALS
a. ICT
b. ICT
c. ICT
30. RECEIPTS REPORTED TO DOE/NRC ON DOE/NRC 741 (not listed elsewhere)
FROM:
RIS
34. RECEIPTS -- MISC
37. PROCUREMENT BY OTHERS
38. DONATED MATERIAL -- FROM U.S. GOVT TO OTHERS
39. DONATED MATERIAL -- FROM OTHERS TO U.S. GOVT
40. TOTAL (Lines 8-39)
REMOVALS
41. EXPENDED IN SPACE PROGRAMS
42. SALES TO U.S. GOVT RIS TO:
RIS
TO:
RIS
43. SALES TO OTHERS FOR THE ACCOUNT OF U.S. GOVT
TO:
44. DOD -- USE A
45. DOD -- USE B
46. DOD -- OTHER USES
47. EXPENDED IN U.S. GOVT TESTS
48. ROUTINE TESTS
49. SHIPPER -- RECEIVER DIFFERENCE
51. SHIPMENTS REPORTED TO NRC/DOE ON NRC/DOE 741 (not listed elsewhere)
TO:
RIS
NRC FORM 742 (04-2018)
Page 1
DOE/NRC FORM 742
U.S. DEPARTMENT OF ENERGY
APPROVED BY OMB: NO. 3150-0004
EXPIRES: 04/30/2021
(04-2018)
Estimated burden per response to comply with this mandatory collection request: 2 hours for
AND
MANDATORY DATA
small licensees and 5 hours for large licensees. Reported lessons learned are incorporated
U.S. NUCLEAR REGULATORY COMMISSION
COLLECTION
into the licensing process and fed back to industry. Send comments regarding burden
AUTHORIZED BY
estimate to the Information Services Branch (T-2 F43), U.S. Nuclear Regulatory
10 CFR 30, 40, 50, 70, 72,
Commission, Washington, DC 20555-0001, or by e-mail to Infocollects.Resource@nrc.gov,
74, 75, 150, Public Laws
83-703, 93-438, 95-91
and to the Desk Officer, Office of Information and Regulatory Affairs, NEOB-10202,
MATERIAL BALANCE REPORT
(3150-0004), 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.
1. NAME AND ADDRESS
2. LICENSE NUMBER(S)
3. REPORTING IDENTIFICATION
SYMBOL (RIS)
5. MATERIAL TYPE
4. REPORT PERIOD (MM/DD/YYYY)
(Submit separate report for each type)
FROM
TO
SECTION A
MATERIAL ACCOUNTABILITY
PC
SEQ
A. ELEMENT WEIGHT B. ISOTOPE WEIGHT
8. BEGINNING INVENTORY -- U.S. GOVT-OWNED
9. BEGINNING INVENTORY -- NOT U.S. GOVT-OWNED
RECEIPTS
11. PROCUREMENT FROM DOE
RIS
FROM:
13. PROCUREMENT -- FOR THE ACCOUNT OF DOE
14. DOD RETURNS -- USE A
15. DOD RETURNS -- USE B
16. DOD RETURNS -- OTHER USES
21. PRODUCTION
22. FROM OTHER MATERIALS
a. ICT
b. ICT
c. ICT
30. RECEIPTS REPORTED TO DOE/NRC ON DOE/NRC 741 (not listed elsewhere)
FROM:
RIS
34. RECEIPTS -- MISC
37. PROCUREMENT BY OTHERS
38. DONATED MATERIAL -- FROM U.S. GOVT TO OTHERS
39. DONATED MATERIAL -- FROM OTHERS TO U.S. GOVT
40. TOTAL (Lines 8-39)
REMOVALS
41. EXPENDED IN SPACE PROGRAMS
42. SALES TO U.S. GOVT RIS TO:
RIS
TO:
RIS
43. SALES TO OTHERS FOR THE ACCOUNT OF U.S. GOVT
TO:
44. DOD -- USE A
45. DOD -- USE B
46. DOD -- OTHER USES
47. EXPENDED IN U.S. GOVT TESTS
48. ROUTINE TESTS
49. SHIPPER -- RECEIVER DIFFERENCE
51. SHIPMENTS REPORTED TO NRC/DOE ON NRC/DOE 741 (not listed elsewhere)
TO:
RIS
NRC FORM 742 (04-2018)
Page 1
DOE/NRC FORM 742
U.S. DEPARTMENT OF ENERGY
AND
(04-2018)
10 CFR 30, 40, 50, 70, 72,
U.S. NUCLEAR REGULATORY COMMISSION
74, 75, 150, Public Laws
83-703, 93-438, 95-91
MATERIAL BALANCE REPORT
(Continued)
SECTION A (Continued)
MATERIAL ACCOUNTABILITY
PC
SEQ
A. ELEMENT WEIGHT B. ISOTOPE WEIGHT
54. SHIPMENTS -- MISC
58. DONATED MATERIAL -- TO U.S. GOVT BY OTHERS
59. DONATED MATERIAL -- TO OTHERS BY U.S. GOVT
65. ROUNDING ADJUSTMENT
a. ICT
71. DEGRADATION TO OTHER MATERIALS
b. ICT
72. DECAY
73. FISSION AND TRANSMUTATION
74. NORMAL OPERATIONAL LOSSES/MEASURED DISCARDS
75. ACCIDENTAL LOSSES
76. APPROVED WRITE-OFFS
77. INVENTORY DIFFERENCE
80. ENDING INVENTORY -- U.S. GOVT OWNED
81. ENDING INVENTORY -- NOT U.S. GOVT OWNED
82. TOTAL (Lines 41-81)
83. BIAS ADJUSTMENT
SECTION B
FOREIGN OBLIGATIONS
SEQ
PC
1. COUNTRY OF OBLIGATION
2. ELEMENT WEIGHT 3.
ISOTOPE WEIGHT
4. TOTAL WEIGHT
SECTION C
CERTIFICATION
To the best of my knowledge and belief, the information given above and in any attached schedules is true, complete, and correct.
TITLE
DATE
SIGNATURE (See instructions for provisions on confidentially)
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.
Page 2
NRC FORM 742 (04-2018)

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