23a. MISCELLANEOUS

DOE/NRC FORM 741

(05-2021) Previous editions are obsolete

MANDATORY DATA COLLECTION

Public Laws 83-703, 93-438, 95-91

NUCLEAR MATERIAL TRANSACTION REPORT

Estimated burden per response to comply with this mandatory collection request: 1 hour and 15 minutes. This information is required for IAEA 

accounting reports that show changes in inventory of nuclear materials. 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 e-mail to Infocollects.

Resource@nrc.gov,and the OMB reviewer at: OMB Office of Information and Regulatory Affairs, (3150-0003), Attn: Desk Officer for the Nuclear 

Regulatory Commission, 725 17th Street NW, Washington, DC 20503; e-mail: 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.

U. S. DEPARTMENT OF ENERGY APPROVED BY OMB: NO. 3150-0003 EXPIRES: 04/30/2024 

AND

U. S. NUCLEAR REGULATORY COMMISSION

1. SHIPPER'S RIS 2. RECEIVER'S RIS 3. TRANSACTION NO. 4. CORRECTION NO. 5. PROCESSING CODE 7. DOCUMENTATION (Only if document is classified SECRET)

a. SHIPPER b. RECEIVER PAGE OF PAGES COPY OF COPIES SERIES

NO. DISTRIBUTION OF COPIES

1

8.a. NAME AND ADDRESS

 OF SHIPPER

b. LICENSE

 NO.

c. ATTENTION:

d. TELEPHONE:

9.a. NAME AND ADDRESS

 OF RECEIVER

b. LICENSE

 NO.

c. ATTENTION:

d. TELEPHONE:

10. NO OF DATA LINES 11. NATURE OF TRANSACTION

12.a. SHIPPED FOR ACCOUNT OF b. RIS 13.a. SHIPPED TO ACCOUNT OF b. RIS

2

3

4

5

6

7

8

9

14. TRANSFER AUTHORITY - CONTRACT, NM DRAFT, OR ORDER NUMBER 15. EXPORT OR IMPORT TRANSFERS: LICENSE NO.

17.

LINE NUMBER

b. SHIPPER'S CORRECTION

c. RECEIPT

d. RECEIVER'S MEASUREMENT

e. RECEIVER'S CORRECTION

a. SHIPMENT

MONTH

(MM)

DAY

(DD)

YEAR

(YYYY)

24. TOTAL GROSS WEIGHT 25. TOTAL VOLUME (Waste Transfers Only)

16. MATERIAL TYPE AND DESCRIPTION

b. CONCISE NOTE ATTACHED

c. UK REPORTABLE? YES NO

BACK

REFERENCE

NUMBER

a.

TYPE

OF INV.

CHANGE

c.

IDENTIFICATION

(ITEM/BATCH NAME)

d.

NO. OF

ITEMS

e.

PROJECT

NUMBER

f.

MATERIAL

TYPE

g.

COMP/

FACILITY

CODE

h.

OWNER

CODE

i.

KEY

MEAS.

POINT

j. 1

BASIS

MEAS. IDENT.

k.

2

OMP

3

METHOD

GROSS WEIGHT

l.

NET WEIGHT

m.

ELEMENT

WEIGHT

n.

ELEMENT

LIMIT OF

ERROR

o.

WEIGHT %

ISOTOPE

p.

ISOTOPE

WEIGHT

q.

ISOTOPE

LIMIT OF

ERROR

r.

26. SHIPPER'S DATA

26s. SHIPPER'S DATA SIGNATURE OF AUTHORIZED OFFICIAL AND DATE SIGNED 27s. RECEIVER'S DATA SIGNATURE OF AUTHORIZED OFFICIAL AND DATE SIGNED

27. RECEIVER'S DATA

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.

18.

COUNTRY OF

OBLIGATION

19.

MATERIAL TYPE

20.

OBLIGATED ELEMENT WEIGHT

21.

OBLIGATED ISOTOPE WEIGHT For Enriched Uranium Only

22. ACTION DATE

LINE

NO.

b.

6. ACTION CODE

a. SHIPPER b. RECEIVER

DOE/NRC FORM 741 (05-2021)

AUTHORIZED BY 10 CFR 30, 40, 50, 70, 

72, 74, 75, 150