1. LICENSEE INFORMATION

NRC FORM 748C

(05-22-2023)

10 CFR 20.2207

U.S. NUCLEAR REGULATORY COMMISSION

NRC FORM 748C (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

7. SOURCE RECEIPT DATA

G1. SOURCE MAKE H1. SOURCE MODEL I1. SOURCE SERIAL

NUMBER

J1. ISOTOPE K1. ACTIVITY AND UNIT L1. ACTIVITY

DATE

T1. COMMENTS

M1. WASTE MANIFEST NO.

B1. SENDING LICENSEE C1. SENDING LICENSEE SHIPPING ADDRESS

LICENSE NO.

A1. SENDING LICENSEE NAME

N1. CONTAINER ID 

O1. SOURCE LOCATION ADDRESS

D1. CITY E1. STATE F1. ZIP CODE

P1. CITY Q1. STATE R1. ZIP CODE S1. SAME AS STREET

ADDRESS

(For waste shipments only) (For waste shipments only)

RECEIVE SOURCE 

NATIONAL SOURCE TRACKING TRANSACTION REPORT

Page 1

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.

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 748C

(05-22-2023)

10 CFR 20.2207

U.S. NUCLEAR REGULATORY COMMISSION

NRC FORM 748C (05-22-2023)

LICENSEE NAME LICENSE NO.

G2. SOURCE MAKE H2. SOURCE MODEL I2. SOURCE SERIAL

NUMBER

J2. ISOTOPE K2. ACTIVITY AND UNIT L2. ACTIVITY

DATE

T2. COMMENTS

M2. WASTE MANIFEST NO.

B2. SENDING LICENSEE C2. SENDING LICENSEE SHIPPING ADDRESS

LICENSE NO.

A2. SENDING LICENSEE NAME

N2. CONTAINER ID 

O2. SOURCE LOCATION ADDRESS

D2. CITY E2. STATE F2. ZIP CODE

P2. CITY Q2. STATE R2. ZIP CODE S2. SAME AS STREET

ADDRESS

G3. SOURCE MAKE H3. SOURCE MODEL I3. SOURCE SERIAL

NUMBER

J3. ISOTOPE K3. ACTIVITY AND UNIT L3. ACTIVITY

DATE

T3. COMMENTS

M3. WASTE MANIFEST NO.

B3. SENDING LICENSEE C3. SENDING LICENSEE SHIPPING ADDRESS

LICENSE NO.

A3. SENDING LICENSEE NAME

N3. CONTAINER ID 

O3. SOURCE LOCATION ADDRESS

D3. CITY E3. STATE F3. ZIP CODE

P3. CITY Q3. STATE R3. ZIP CODE S3. SAME AS STREET

ADDRESS

(For waste shipments only)

(For waste shipments only) (For waste shipments only)

(For waste shipments only)

7. SOURCE RECEIPT DATA (continued)

Page 2

RECEIVE 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.
NRC FORM 748C

(05-22-2023)

10 CFR 20.2207

U.S. NUCLEAR REGULATORY COMMISSION

NRC FORM 748C (05-22-2023)

LICENSEE NAME LICENSE NO.

7. SOURCE RECEIPT DATA (continued)

G4. SOURCE MAKE H4. SOURCE MODEL I4. SOURCE SERIAL

NUMBER

J4. ISOTOPE K4. ACTIVITY AND UNIT L4. ACTIVITY

DATE

T4. COMMENTS

M4. WASTE MANIFEST NO.

B4. SENDING LICENSEE C4. SENDING LICENSEE SHIPPING ADDRESS

LICENSE NO.

A4. SENDING LICENSEE NAME

N4. CONTAINER ID 

O4. SOURCE LOCATION ADDRESS

D4. CITY E4. STATE F4. ZIP CODE

P4. CITY Q4. STATE R4. ZIP CODE S4. SAME AS STREET

ADDRESS

G5. SOURCE MAKE H5. SOURCE MODEL I5. SOURCE SERIAL

NUMBER

J5. ISOTOPE K5. ACTIVITY AND UNIT L5. ACTIVITY

DATE

T5. COMMENTS

M5. WASTE MANIFEST NO.

B5. SENDING LICENSEE C5. SENDING LICENSEE SHIPPING ADDRESS

LICENSE NO.

A5. SENDING LICENSEE NAME

N5. CONTAINER ID 

O5. SOURCE LOCATION ADDRESS

D5. CITY E5. STATE F5. ZIP CODE

P5. CITY Q5. STATE R5. ZIP CODE S5. SAME AS STREET

ADDRESS

(For waste shipments only)

(For waste shipments only) (For waste shipments only)

(For waste shipments only)

RECEIVE 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