Attachment_6_Request_Form396.pdf

PDF 968 KB Posted Jun 30, 2014

Attached to: TECHNICAL ASSISTANCE TO SUPPORT NRC REVIEW OF NRC FORM 396, CERTIFICATION OF MEDICAL EXAMINATION BY FACILITY LICENSEE
Solicitation number: NRC-HQ-60-14-R-0005
Issued by: Nuclear Regulatory Commission Central Office

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Attachment 6

File	Type	Posted
Amendment_000001.pdf	PDF	Jul 1, 2014
Attachment_2_Subpart_2009.5 1 2 .pdf	PDF	Jun 30, 2014
Combined_Synopsis-Solicitation.pdf	PDF	Jun 30, 2014
Attachment_4-BillingInsCR.pdf	PDF	Jun 30, 2014
Attachment_5_BillingInsLH.pdf	PDF	Jun 30, 2014
Attachment_3_BillingInstructionsFFP.pdf	PDF	Jun 30, 2014
ENCLOSURE_1_UNDER_THE_SOW.pdf	PDF	Jun 30, 2014

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US Nuclear Regulatory Commission

REQUEST REVIEW FORM 396

Contract No. NRC-XX-XX-XXX

1. Date 2. Delivery Order Number 3. Delivery Order Title

Review Operator Medicals (NRC Form 396) and make recommendations (NRC Form 396A)

4. NRC Project Officer/COR 5. E-mail Address 6. Phone Number

7. NRC Technical Monitor 8. E-mail Address 9. Phone Number

NRC Provided Materials

13. Documents/Materials Provided:

Date Provided:

Delivery Order Schedule

11. Required Task Completion Date

12.

Deliverable Due Dates

13. CLIN 14. Quantity 15. Price

(per contract schedule of supplies/services)

Task: Start:

Complete:

16. Total Cost $

Acknowledgment and Acceptance of Delivery Order

Signature and Title – Contractor Date

Signature - NRC Project Officer/COR Date cxm5 Typewritten Text

ATTACHMENT 6

File details come from the government source that posted it. Updated Nov 14, 2017.