To certify the medical fitness of the applicant, an authorized representative of the facility licensee shall complete and sign NRC Form 396, ``Certification of Medical Examination by Facility Licensee,'' which can be obtained by writing the Office of Information Services, U.S. Nuclear Regulatory Commission, Washington, DC 20555-0001, by calling (301) 415-7232, or by visiting the NRC's Web site at http://www.nrc.gov and selecting forms from the index found on the home page.
(a) Form NRC-396 must certify that a physician has conducted the medical examination of the applicant as required in Sec. 55.21.
(b) When the certification requests a conditional license based on medical evidence, the medical evidence must be submitted on NRC Form 396 to the Commission and the Commission then makes a determination in accordance with Sec. 55.33. [52 FR 9460, Mar. 25, 1987, as amended at 53 FR 43421, Oct. 27, 1988; 68 FR 58813, Oct. 10, 2003; 73 FR 30458, May 28, 2008]