Form for Public to Propose a Generic Issue (GI)

E-MAIL FORM:
Identify Source(s) of Information for this Proposed GI (Self, Publication(s), Web site(s), Transcripts from Meeting(s), Other) – Please describe and provide contact information for GIP representatives to obtain more information, as appropriate.

Name or Person Submitting Request:

Affiliation:

Date of Request:

Mailing Address:

Address1:

City:

State:
--- AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY

ZIP/Postal Code:

Country:

Telephone:

E-Mail Address:

Other Contacts:

INSTRUCTIONS FOR PROVIDING RESPONSES BELOW:
Describe situation, condition, issue, or concern by providing the following information to extent practical (i.e., use readily available information, these requests are not intended to cause an imposition). Describe basis for statements as available or indicate opinion or belief, as applicable. Contact a GIP representative for assistance completing these responses.

If you do not know how to respond to any question, then put “Don’t know.”

What occurs, occurred, or what could occur (performance requirement, standard, or expectation not met, or potentially compromised)?

When it occurs, occurred, or could occur (time and circumstances)?

Where it occurs, occurred, or could occur (physical location from general to specific and in a sequence of process steps or activities)?

Adverse consequences of occurrence (actual and potential damages and other negative impacts)?

Frequency of occurrence (relevant historical rate, best estimate of rate, and conditions that influence the rate)?

Significance of occurrence (reasons it is important)?

Ability to anticipate and prevent occurrence (leading indicators or signs)?

Means to detect or discover occurrence (supporting evidence)?

Estimated likelihood of occurrence (best estimate of chance under expected conditions)?

Causes of occurrence (set of necessary and sufficient actions and conditions)?

Suggestions for corrective actions (remedies to prevent adverse consequences)?

INSTRUCTIONS FOR PROVIDING RESPONSES BELOW:
To ensure the issue is directed to the appropriate NRC Programs and Processes for timely and effective assessment, please provide the following information to extent practical (i.e., use readily available information, these requests are not intended to cause an imposition). Describe basis for statements as available or indicate opinion or belief, as applicable. If you do not know how to respond to any question, then put “Don’t know.” Contact a GIP representative for assistance completing these responses.

Issue impacts (or has potential to impact) public health and safety, common defense and security, or environment.

Please explain below:

Issue indicates susceptibility of, or has applicability to, multiple licensees or entities regulated by NRC.

Please explain below:

Issue indicates there are gaps, voids, conflicts, or excess in existing regulations or industry standards causing inadequate protection, opportunity to substantially improve safety, or undue regulatory burden.

Please explain below:

Issue resolution will likely result in new or revised regulation, policy, or guidance to prevent issue’s occurrence.

Please explain below:

Issue will not require substantial new research to assess risk or safety significance or to gain sufficient understanding to support initial screening assessment (i.e., issue parameters are identified and sufficiently understood to support further assessment of the likelihood that the issue would cause or result in a severe accident).

Please explain below:

Issue is discrete with clear and specific technical scope (bounding physical conditions).

Please explain below:

Issue will likely result in actions by licensees or entities regulated by NRC to address issue.

Please explain below:

Others Consulted or Contacted:

Date:

Provide Comments, Additional Information, Attachments, or References (as desired and appropriate to support comments above).

Please submit completed form, below. Alternately, you can send the completed form in US Mail to US Nuclear Regulatory Commission, Generic Issues Program, Washington, DC 20555-0001, Mail Stop C-2C07M.