1. LICENSEE INFORMATION

NRC FORM 748H

(05-22-2023)

10 CFR 20.2207

DISASSEMBLE SOURCE 

NATIONAL SOURCE TRACKING TRANSACTION REPORT

U.S. NUCLEAR REGULATORY COMMISSION

NRC FORM 748H (05-22-2023)

APPROVED BY OMB: NO. 3150-0202 EXPIRES: 05/31/2026

A. LICENSEE NAME B. LICENSE NO. C. LICENSEE STREET ADDRESS

A. NAME OF PREPARER B. DATE PREPARED C. PREPARER PHONE 

4. PREPARER INFORMATION

(Only transactions completed on the same

date may be reported together on this form) NEW CORRECTION

3B. TRANSACTION TYPE (Check all that apply)

REPORT SOURCE TRANSFER RECEIPT

DISASSEMBLE

DISPOSAL

NEW SOURCE 

MANUFACTURED

IF CORRECTION, PREVIOUS TRANSACTION DATE:

IMPORT EXPORT

D. PREPARER E-MAIL (REQUIRED FOR CONFIRMATION)

2. TRANSACTION DATE 3A. TRANSACTION INFORMATION

D. CITY E. STATE F. ZIP CODE

INVENTORY

12. SOURCE DISASSEMBLE DATA

A1. SOURCE MAKE B1. SOURCE MODEL C1. SOURCE SERIAL

NUMBER

D1. ISOTOPE E1. ACTIVITY

I1. SOURCE LOCATION ADDRESS M1. SAME AS

STREET ADDRESS

H1. COMMENTS

J1. CITY K1. STATE L1. ZIP CODE

G1. DISASSEMBLE

DATE

F1. ACTIVITY

AND UNIT DATE

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 1

Estimated burden per response to comply with this mandatory information collection request: 9.5 minutes. NRC requires this information to populate 

the National Source Tracking System for certain sealed sources. 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, (3150-0202), Attn: Desk Officer for the Nuclear Regulatory 

Commission, 725 17th Street NW, Washington, DC 20503; email: oira_submission@omb.eop.gov. 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.
NRC FORM 748H

(05-22-2023)

10 CFR 20.2207

U.S. NUCLEAR REGULATORY COMMISSION

NRC FORM 748H (05-22-2023)

LICENSEE NAME LICENSE NO.

12. SOURCE DISASSEMBLE DATA (continued)

A2. SOURCE MAKE B2. SOURCE MODEL C2. SOURCE SERIAL

NUMBER

D2. ISOTOPE E2. ACTIVITY

I2. SOURCE LOCATION ADDRESS M2. SAME AS

STREET ADDRESS

H2. COMMENTS

J2. CITY K2. STATE L2. ZIP CODE

A3. SOURCE MAKE B3. SOURCE MODEL C3. SOURCE SERIAL

NUMBER

D3. ISOTOPE E3. ACTIVITY

AND UNIT

I3. SOURCE LOCATION ADDRESS M3. SAME AS

STREET ADDRESS

H3. COMMENTS

J3. CITY K3. STATE L3. ZIP CODE

A4. SOURCE MAKE B4. SOURCE MODEL C4. SOURCE SERIAL

NUMBER

D4. ISOTOPE E4. ACTIVITY

AND UNIT

I4. SOURCE LOCATION ADDRESS M4. SAME AS

STREET ADDRESS

H4. COMMENTS

J4. CITY K4. STATE L4. ZIP CODE

A5. SOURCE MAKE B5. SOURCE MODEL C5. SOURCE SERIAL

NUMBER

D5. ISOTOPE E5. ACTIVITY

AND UNIT

I5. SOURCE LOCATION ADDRESS M5. SAME AS

STREET ADDRESS

H5. COMMENTS

J5. CITY K5. STATE L5. ZIP CODE

G2. DISASSEMBLE

DATE

F2. ACTIVITY

DATE

G3. DISASSEMBLE

DATE

F3. ACTIVITY

DATE

G4. DISASSEMBLE

DATE

F4. ACTIVITY

DATE

G5. DISASSEMBLE

DATE

F5. ACTIVITY

DATE

AND UNIT

DISASSEMBLE SOURCE 

NATIONAL SOURCE TRACKING TRANSACTION REPORT 

(continued)

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 748H

(05-22-2023)

10 CFR 20.2207

U.S. NUCLEAR REGULATORY COMMISSION

NRC FORM 748H (05-22-2023)

LICENSEE NAME LICENSE NO.

A6. SOURCE MAKE B6. SOURCE MODEL C6. SOURCE SERIAL

NUMBER

D6. ISOTOPE E6. ACTIVITY

I6. SOURCE LOCATION ADDRESS M6. SAME AS

STREET ADDRESS

H6. COMMENTS

J6. CITY K6. STATE L6. ZIP CODE

A7. SOURCE MAKE B7. SOURCE MODEL C7. SOURCE SERIAL

NUMBER

D7. ISOTOPE E7. ACTIVITY

AND UNIT

I7. SOURCE LOCATION ADDRESS M7. SAME AS

STREET ADDRESS

H7. COMMENTS

J7. CITY K7. STATE L7. ZIP CODE

A8. SOURCE MAKE B8. SOURCE MODEL C8. SOURCE SERIAL

NUMBER

D8. ISOTOPE E8. ACTIVITY

AND UNIT

I8. SOURCE LOCATION ADDRESS M8. SAME AS

STREET ADDRESS

H8. COMMENTS

J8. CITY K8. STATE L8. ZIP CODE

A9. SOURCE MAKE B9. SOURCE MODEL C9. SOURCE SERIAL

NUMBER

D9. ISOTOPE E9. ACTIVITY

AND UNIT

I9. SOURCE LOCATION ADDRESS M9. SAME AS

STREET ADDRESS

H9. COMMENTS

J9. CITY K9. STATE L9. ZIP CODE

G6. DISASSEMBLE

DATE

F6. ACTIVITY

DATE

G7. DISASSEMBLE

DATE

F7. ACTIVITY

DATE

G8. DISASSEMBLE

DATE

F8. ACTIVITY

DATE

G9. DISASSEMBLE

DATE

F9. ACTIVITY

DATE

AND UNIT

12. SOURCE DISASSEMBLE DATA (continued)

DISASSEMBLE SOURCE 

NATIONAL SOURCE TRACKING TRANSACTION REPORT 

(continued)

Page 3

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.
INSTRUCTIONS TO NRC AND AGREEMENT STATE LICENSEES FOR REPORTING HIGH-RISK SEALED SOURCE TRANSACTIONS 

The completed form is considered to be Official Use Only – Security Related Information; it is not considered to be Safeguards Information. 

Use an addendum sheet for reporting additional sources.

Note to Licensees: This form may be used to report source transactions in lieu of 

using the NSTS online application. Sections 1-4 on Page 1 of the form are required 

for all source transaction types. Sections 5-12 should only be populated for the 

associated Transaction Type (3B) selected. For example, when reporting a Source 

Transfer and a Source Export, Sections 6 and 11 should be populated. Multiple 

Transaction Types may be selected if they occur on the same Transaction Date, and 

should be reported on NRC Form 748. Licensees reporting only one transaction type 

may use the condensed form for the Transaction Type. For example, when reporting 

a Source Receipt, NRC Form 748c should be used. 

1. Licensee Information – Enter the name, license number, and street address of 

the licensed facility. 

2. Transaction Date – Enter the date the transaction occurred, which would be the date 

of the transfer, receipt, manufacture, etc. 

3. Transaction Information and Transaction Type – Indicate if this is a new transaction

or a correction. For corrections, select the date of the previously submitted 

transaction that the correction should be associated with. Select the Transaction 

Type. Report Source should only be used for initial inventory submissions, or to 

report a source excluded from the initial inventory submission. Dispose Source 

should only be used by a Disposal Licensee. If you are sending your source back to 

the manufacturer, or sending it to a disposal facility, the transaction should be 

recorded as a Transfer. Multiple Transaction Types may be selected if they occur on 

the same Transaction Date. 

4. Preparer Information – An email address is required for a confirmation. For

regulatory purposes, your source transaction report is not considered complete 

without a confirmation from the NSTS Help Desk that the transaction report has 

been received. 

5. Source Inventory Data – This section should only be used for initial inventory 

submissions. The Make, Model, and Serial Number refer to the Source, not the 

Device. All fields are required in Section 5 EXCEPT G. Comments. If the licensee is 

reporting multiple sources on the Source Inventory transaction at the same Source 

Location Address, the location address information may be populated once, and 

referenced in the Comments block for the additional sources. 

6. Source Transfer Data – For Transfer transaction reports, all fields in Section 6 are 

required EXCEPT M. Waste Manifest Number, N. Container ID, and P. Comments. If 

the licensee is reporting multiple sources on the Transfer transaction to the same 

Receiving Licensee, the receiving licensee information may be populated once, and 

referenced in the Comments block for the additional sources. 

7. Source Receipt Data – For Receipt transaction reports, all fields in Section 7 are 

required EXCEPT M. Waste Manifest Number, N. Container ID, and T. Comments. If 

the licensee is reporting multiple sources on the Receipt transaction at the same 

Source Location Address, the location address information may be populated once, 

and referenced in the Comments block for the additional sources. 

8. Source Disposal Data – For Disposal transaction reports, all fields in Section 8 are 

required EXCEPT J. Comments. If the licensee is reporting multiple sources on the 

Disposal transaction at the same Source Disposal Address, the source disposal 

address information may be populated once, and referenced in the Comments block 

for the additional sources. 

9. New Manufactured Source Data – For New Manufactured Source transaction 

reports, all fields in Section 9 are required EXCEPT F. Comments. If the licensee is 

reporting multiple sources on the Manufacturer transaction at the same Source 

Location Address, the location address information may be populated once, and 

referenced in the Comments block for the additional sources. 

10. Source Import Data – For Import Source transaction reports, all fields are required 

EXCEPT L. Comments. If the licensee is reporting multiple sources on the Import 

transaction at the same Source Location Address, the location address information 

may be populated once, and referenced in the Comments block for the additional 

sources. 

11. Source Export Data – For Export Source transaction reports, all fields are required 

EXCEPT M. Comments. If the licensee is reporting multiple sources on the Export 

transaction to the same Foreign Company/Foreign Address, the information in cells 

A-E may be populated once, and referenced in the Comments block for the 

additional sources. 

12. Source Disassemble Data – For Disassemble Source transaction reports, all fields 

are required EXCEPT H. Comments. If the licensee is reporting multiple sources on 

the Disassemble transaction at the same Source Location Address, the location 

address information may be populated once, and referenced in the Comments block 

for the additional sources. 

DISTRIBUTION

For most timely processing, click the "Submit by Email" button on page 1. 

You may also: 

 > manually submit this form by email to: NSTSFax.Resource@nrc.gov, 

 > FAX to: 1-888-821-2534, or 

 > mail to: NSTS Help Desk 

 9737 Washingtonian Blvd, Room #3145, Mail Stop #9 

 Gaithersburg, MD 20878