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DOE F 5484.3 (09-95) All Other Editions Are Obsolete U.S. Department of Energy OMB Control No. 1910-0300 INDIVIDUAL ACCIDENT/INCIDENT REPORT Official Use Only Privacy Accusers Use Only P.D. Accident
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The specific entities or individuals who require DOE Form 5484-3 will vary depending on the purpose and context of its use. It is important to refer to the instructions or consult the relevant authorities to determine if this form is required in a particular situation.
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