UNITED STATES 

NUCLEAR REGULATORY COMMISSION 

REGION I 

2100 RENAISSANCE BLVD., SUITE 100 

KING OF PRUSSIA, PA 19406-2713 

July 5, 2016 

Geoffrey Korir, Director 

Office of Radiological Health 

Department of Health and Mental Hygiene 

42-09 28th Street, 14th Floor CN #60 

Long Island City, NY 11101 

Dear Mr. Korir: 

A periodic meeting with you and your staff was held on May 3, 2016. The purpose of this 

meeting was to review and discuss the status of the New York Agreement State Program. The 

U.S. Nuclear Regulatory Commission (NRC) was represented by James Trapp, Lisa Dimmick, 

and me. 

I have completed and enclosed a general meeting summary. If you feel that our conclusions do 

not accurately summarize the meeting discussion, or have any additional remarks about the 

meeting in general, please contact me at (610) 337-5371 or via e-mail at Donna.Janda@nrc.gov

to discuss your concerns. 

 Sincerely, 

 /RA/ 

 Donna M. Janda 

 Regional State Agreements Officer 

 Division of Nuclear Materials Safety 

 

Enclosure: 

Periodic Meeting Summary for New York City 

 
July 5, 2016 

Geoffrey Korir, Director 

Office of Radiological Health 

Department of Health and Mental Hygiene 

42-09 28th Street, 14th Floor CN #60 

Long Island City, NY 11101 

Dear Mr. Korir: 

A periodic meeting with you and your staff was held on May 3, 2016. The purpose of this 

meeting was to review and discuss the status of the New York Agreement State Program. The 

U.S. Nuclear Regulatory Commission (NRC) was represented by James Trapp, Lisa Dimmick, 

and me. 

I have completed and enclosed a general meeting summary. If you feel that our conclusions do 

not accurately summarize the meeting discussion, or have any additional remarks about the 

meeting in general, please contact me at (610) 337-5371 or via e-mail at Donna.Janda@nrc.gov

to discuss your concerns. 

 Sincerely, 

 /RA/ 

 Donna M. Janda 

 Regional State Agreements Officer 

 Division of Nuclear Materials Safety 

 

Enclosure: 

Periodic Meeting Summary for New York City 

Distribution: 

L. Dimmick, NMSS D. Collins, NMSS P. Michalak, NMSS 

P. Henderson, NMSS M. Ford, RI DNMS D. Janda, RI DNMS 

J. Trapp, RI DNMS J. Nick, RI DNMS 

SUNSI Review Complete: DMJ (Reviewer’s Initials) 

\\nrc.gov\nrc\R1\Shared\State Agreement Files\New York\NYC May 2016 Periodic Meeting Summary and Transmittal 

Letter.docx ML16194A481 

After declaring this document “An Official Agency Record” it will be released to the Public. 

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OFFICE DNMS/RI 

NAME Janda/dmj 

DATE 07/05/16 

 
AGREEMENT STATE PERIODIC MEETING SUMMARY FOR 

NEW YORK CITY DEPARTMENT OF HEALTH AND MENTAL HYGIENE 

OFFICE OF RADIOLOGICAL HEALTH 

DATE OF MEETING: May 3, 2016 

U.S. Nuclear Regulatory 

Commission (NRC) Attendees 

New York City Office of Radiological Health 

Attendees 

Donna Janda, State Agreements 

Officer, Region I 

Geoffrey Korir, Director 

James Trapp, Director, Division of 

Nuclear Materials Safety, Region I 

Rejina Alam, Chief, Radiological Health Unit 

Lisa Dimmick, Senior Health Physicist, 

Agreement State Programs Branch, 

Office of Nuclear Material Safety and 

Safeguards 

 Narenta Bici, Radiological Analyst 

 Jose Lorenzo, RAM Inspection Supervisor 

 Hailu Tedla, RAM Licensing Section 

DISCUSSION: 

The agencies which comprise the New York Agreement State program (Program) are the New 

York State Department of Health (DOH), which has jurisdiction over industrial uses of 

radioactive material throughout the State as well as medical, academic, and research uses 

outside the five boroughs of New York City; New York State Department of Environmental 

Conservation (DEC), which has jurisdiction throughout the State over discharges of radioactive 

material to the environment, including releases to the air and water, and the disposal of 

radioactive waste in the ground; and New York City Department of Health and Mental Hygiene 

(NYC), which has jurisdiction over medical, academic, and research uses of radioactive material 

within the five boroughs of New York City. During the March 2014 Integrated Materials 

Performance Evaluation Program (IMPEP) review of the New York Program, the review team 

found the State’s performance satisfactory for five performance indicators; satisfactory, but 

needs improvement, for the performance indicator, Technical Staffing and Training; and 

unsatisfactory for the performance indicator, Compatibility Requirements. The review team 

found the performance indicator, Technical Quality of Licensing Actions, to be satisfactory, but 

needs improvement; however, the Management Review Board (MRB) determined this indicator 

should be found satisfactory. The review team made three recommendations regarding 

program performance in technical staffing, technical quality of licensing, and compatibility 

requirements, and determined that the six recommendations from the 2011 IMPEP review, 

regarding reciprocity inspections, development of an action plan to adopt NRC regulations, and 

incident reporting and incident procedures, should be closed. 

On August 4, 2014, the MRB found the Program to be adequate to protect public health and 

safety and not compatible with NRC’s program. The MRB commended the Program for 

progress made under the indicator, Technical Quality of Incident and Allegation Activities, where 

performance was improved from unsatisfactory to satisfactory during the review period, and for 

the progress made in adopting several overdue rules. As a result, the MRB directed that the 

period of Heightened Oversight be discontinued and a period of Monitoring be initiated. The 

MRB directed that quarterly calls be conducted between the New York and NRC staffs. The 

MRB also directed that a Periodic Meeting be conducted in approximately March 2016. This 

report is a summary of the Periodic Meeting held with NYC.
New York City Periodic Meeting Summary 2 

TOPICS COVERED DURING THE MEETING INCLUDED: 

Program Strengths 

• Staffing levels in licensing and inspection areas have improved since the 2014 IMPEP 

review. The Program has two qualified license reviewers and two license reviewers 

undergoing qualification training. The Program also has three qualified materials 

inspectors and one materials inspector undergoing qualification training. The Program 

has a new Unit Chief and a new Radiological Analyst. 

• The Program has updated licensing and inspection forms for use by technical staff 

• The Program has developed an in-house training program which focuses on job 

activities. The Program uses grant money to conduct training such as Radiation Safety 

Officer training to be held in May 2016 and for an annual RSO Symposium to discuss 

current topics (such as 10 CFR Part 37). 

• The Program also participates in NRC qualification training courses as appropriate. 

Program Challenges 

• Revision of the NYC Health Code in conjunction with adoption of NRC’s regulations by 

reference 

• Customizing the NRC training requirements in Inspection Manual Chapter (IMC) 1248 to 

meet the needs of NYC Program staff 

• Development of an internal audit program 

• Having qualified full-time technical staff. Some staff split their time between radioactive 

materials work and other activities such as radiological response. 

Feedback on the NRC’s Program 

The Program noted that there is good communication and support from NRC. The Program 

also appreciates the training courses and opportunities provided by NRC. The Program is 

interested in having NRC participate in an upcoming workshop to discuss risk communication. 

The Program would also appreciate more NRC-sponsored webinars on current topics and other 

training opportunities, including the possibility of NYC hosting NRC-sponsored training. The 

Program is considering moving to a paperless system and is interested in web-based licensing. 

Organization 

There have been no reorganizations affecting the Program since the 2014 IMPEP review. The 

NYC Program is administered by the Office of Radiological Health which is part of the Bureau of 

Environmental Sciences and Engineering within the Department of Health and Mental Hygiene. 

The Program is managed by the Program Director and the Unit Chief. The Program also has 

one licensing supervisor and one inspection supervisor. 

Program Budget/Funding 

Program funds are placed into the NYC general fund. The Program’s budget has had modest 

increases each fiscal year since the 2014 IMPEP review. 

 
New York City Periodic Meeting Summary 3 

Technical Staffing and Training (2014 IMPEP: Satisfactory, but Needs Improvement) 

At the time of the Periodic Meeting, the Program devoted seven technical staff, including the 

licensing and inspection supervisor positions, and one Unit Supervisor, to the radioactive 

materials program for a total of approximately 7.6 full-time equivalents (FTE). The Program also 

has a Program Analyst who devotes 0.3 FTE to materials licensing. The Licensing Section has 

two fully qualified technical staff and one vacant position and the Inspection Section has three 

fully qualified inspectors and one inspector undergoing qualification training. The Unit 

Supervisor and Program Analyst perform some licensing activities and are undergoing 

qualification training. Since the 2014 IMPEP review, two individuals retired from the Program, 

including a Licensing Supervisor, and five individuals were hired into the Program, including the 

Program Director and Unit Supervisor. The vacant position has been posted and the Program 

Director expects interviews will start soon. 

The 2014 IMPEP review team made one recommendation for NYC in this indicator: 

Recommendation: The review team recommends that NYC should update its staffing and 

training qualification program to include approved documentation of staff’s qualifications. 

Status: Since the 2014 IMPEP review, NYC has developed and implemented a documented 

training and qualification program that is equivalent to NRC IMC 1248. The documents were 

provided to the NRC RSAO for review and comment prior to the meeting. The Program 

conducts several in-house training sessions each year and hosts symposiums for the NYC 

licensee community. Refresher training is conducted and documented for qualified technical 

staff. 

Status of Materials Inspection Program (2014 IMPEP: Satisfactory) 

The Program reported it has conducted 277 inspections since the 2014 IMPEP review. None of 

these inspections were completed overdue according to the priorities established in NRC IMC 

2800. No inspections are currently overdue. The Program has completed 36 initial inspections 

since the 2014 IMPEP review, none of which were completed overdue (i.e., greater than 12 

months after license issuance). If the licensee does not possess radioactive material, the 

Program will conduct the inspection anyway and set the next inspection date for no later than 

one year. The Program has conducted 16 reciprocity inspections since the 2014 IMPEP review. 

Technical Quality of Inspections (2014 IMPEP: Satisfactory) 

The Program is in the process of updating their inspection procedures to include specific 

inspection forms for various modalities regulated by NYC. The Program uses inspection 

procedures that are consistent with the inspection guidance outlined in IMC 2800. Inspectors 

discuss inspection findings with the Inspection Supervisor and provide the inspection 

documentation to the supervisor for review. Once the inspection report/letter is approved by the 

supervisor, the document is provided to the Unit Chief for review and approval. The Program 

has performed 11 supervisor inspection accompaniments since the 2014 IMPEP review and is 

on track to meet the goal of at least one supervisory accompaniment for each qualified materials 

inspector on an annual basis. The Program anticipated starting Part 37 inspections in May 

2016. Approximately 12 facilities are subject to Part 37, some of which have multiple modalities 

subject to these new requirements. 
New York City Periodic Meeting Summary 4 

Technical Quality of Licensing Actions (2014 IMPEP: Satisfactory) 

At the time of the Periodic Meeting, the Program reported having 350 specific licenses. Since 

the 2014 IMPEP review, the Program has implemented a peer review process for all licensing 

actions to ensure that the actions are complete and well-documented. NYC uses NUREG-1556 

licensing guidance and the NRC pre-licensing guidance on applicable licensing actions. 

The 2014 IMPEP review team made one recommendation for NYC in this indicator: 

Recommendation: The review team recommends that NYC (1) provide additional training to 

technical staff members regarding technical review of licensing actions, including training to 

ensure that the staff acquires increased familiarity with the regulations under NYC’s equivalent 

to 10 CFR Parts 30, 33, and 35, and applicable licensing guidance documents and license 

conditions, and (2) take measures to ensure that the NYC’s review of licensing actions are 

complete and well-documented. 

Status: (1) NYC has used a variety of training opportunities to meet this part of the 

recommendation, including on-the-job training, NRC-sponsored training, and NYC customized 

training classes. One example of in-house training is a three-day class on radiation safety 

training being conducted for the radioactive materials staff by a contractor in May 2016. This 

course will cover topics such as radiation protection standards, medical use licensing, and 

security of radioactive materials. In-house training is documented on a new form entitled “InHouse Training for Materials Licensing and Inspection”. (2) Since the 2014 IMPEP review, the 

Program has established standard operating procedures for licensing actions, including 

procedures to ensure that documentation generated from deficiency letters, emails, and 

telephone conversations with licensees is maintained in the license files. As part of the 

licensing review process, licensing staff review the licensee’s history, evaluate the historical 

licensing and inspection documentation, and perform a quality assurance assessment of the 

licensee file including a review of licensees’ compliance history. Protocol was developed to 

ensure appropriate documentation is compiled for license termination actions. Peer reviews of 

all licensing actions are used to ensure that documentation of the action is complete. 

Technical Quality of Incidents and Allegation Activities (2014 IMPEP: Satisfactory) 

At the time of the Periodic Meeting, the Program had reported seven events to the NRC. Two of 

these events were reported to the Nuclear Materials Event Database but were not reported to 

the NRC Headquarters Operations Center (HOC) as required for these types of events. The 

Program noted that this was an inadvertent oversight and committed to reporting the events to 

the HOC in order to meet the reporting requirements. The Program received two allegations 

since the 2014 IMPEP review, both were received in 2016. The Program conducts follow up 

activities, including onsite inspections, for incidents and allegations as appropriate. 

Compatibility Requirements (2014 IMPEP: Unsatisfactory) 

The 2014 IMPEP review team made one recommendation for NYC in this indicator: 

Recommendation: the review team recommends that the Program make appropriate 

regulatory changes to resolve NRC-generated comments as noted in regulation review letters, 

and adopt NRC regulations in accordance with the current NRC policy on adequacy and 

compatibility. 
New York City Periodic Meeting Summary 5 

Status: Since the 2014 IMPEP review, NYC has drafted proposed regulations to adopt all 

applicable NRC regulations by reference. On February 26, 2016, NYC submitted these 

proposed regulations to NRC for review. Once NYC receives NRC comments, the proposed 

repeal and reenactment of New York Health Code, Article 175, which governs radiological 

health, will be presented to the New York City Board of Health at its June 2016 meeting to 

initiate a 30-day public comment period and subsequent adoption by the Board at its September 

2016 meeting. Once the regulations become final, NYC will submit the final regulations to NRC 

for review. 

CONCLUSIONS: 

The NYC Agreement State Program continues to be an effective, well maintained program. The 

Program had one vacancy in the licensing section at the time of the periodic meeting. The 

Program continues to address the recommendations made for the NYC program during the 

2014 IMPEP review. The Program is effectively managing its licensing and inspection activities 

and responds to incidents and allegations as appropriate. The Program has made significant 

progress in adopting NRC regulations by reference. 

NRC staff recommends that the next IMPEP review be conducted as scheduled in March 2018.