ML19325F106

Request for OMB Review & Supporting Statements Re NRC Form 354, Data Rept on Spouse. Estimated Respondent Burden Is 22 H

ML19325F106
Person / Time
Issue date:	11/01/1989
From:	Amenta J NRC OFFICE OF INFORMATION RESOURCES MANAGEMENT (IRM)
To:
References
OMB-3150-0026, OMB-3150-26, NUDOCS 8911140114
Download: ML19325F106 (9)

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Road instructions before completing form. Do not use the same SF 63 Send three copeet of this foim, the material to be reybwed, and for f3 request both an Executive Order 12291 review and approval under paperwork-three copies of the supputting statement, to:

the Paperwork Reduction Act.

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Answer all questions in Part 1. If this request is for review under E.O.'

Of fice of Information and Regulatory Affairs 12291, complete Part il and sign tho regulatory certification. If this Office of Management and Budget request is for approval under the Paperwork Reduction Act and 5 CFR Attention: Docnet Library, Room 32011

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1320, Skip Part II, complete Part lli and sign the paperwork certification.

WaW ; ton,DC20:33 PART I,-Complete This Part for All Requests.

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4. Title cf intormotion collection or rulemakinC

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NRC Form ~354, " Data Report on Spouse" 1

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PART li.-Comp;4te This Part only if the Request is for OMB Review Under Executive Order 12291 l

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PDR ORG EUSCMD t} t PDC V

s OM3 SUPPORTING STATEMENT FOR NRC FORM 354

" DATA REPORT ON SPOUSE" j,

Cescription of Information Collection. This reporting requirement affects approximately 88 individuals annually. The respondents are NRC contractors, NRC licensee applicants, and NRC employment applicants who are married to non-U.S. citizens and are applying for NRC access authorization or emp1pyment clearance. The form must also be completed by respondents who marry after completing the Personnel Security Forms, or after having been granted an NRC access authorization or emp1pynent cleararce.

A.

Justification 1.

Need for the Collection of Information.

Section 145 of the Atomic Energy Act (AEA) of 1954, as amended, requires, before an individual can be grantedaccesstoRestrictedData(RD),aninvestigationandreporton the individual's character, associations and loyalty and a determination that permitting such a person access to RD will not endanger the common defense and security.

The basic security standard of Executive Order 10450, " Security Require-ments for Government Employnent," for emp1pyment, o~ retention of an individual in a sensitive position, is that such emp1pyment or retention

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l' is " clearly consistent with the interests of the national security."

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Executive Order 10865. " Safeguarding Classified Information Within F

Industry,' likewise permits the "... head of a department or his designee..." to grant access authorizations for industrial employees l

(NRC contractors) "... only upon finding that it is clearly consistent with the national interest to do so.*

10 CFR Part 10, Subpart 8. " Criteria and Procedures for Determining Eligi-bility for Access to Restricted Data or National Security Informatiun or an Employment Clearance, provides criteria to assist in making this determi-nation.

In order for NRC to implement this responsibility, it is pertinent, from a security standpoint, that NRC receive information concerning (1) non-U.S. citizen spouses of NRC applicants; (2) non-U.S. citizen spouses of NRC contractor and licensee employees pending NRC access author 14ation processing; (3) spouses of NRC applicants, contractor or licensee employees who marry after applying for NRC access authorization; and (4) spouses of NRw contractor and NRC licensee employees who marry after having been granted NRC access authorization.

2.

Agency Use of Information. The informatice supplied identifies the respondent, marriage, and data on the spouse and spouse's relatives. This information permits an initial security determination by the NRC Division i

of Security as to whether or not any information on the form has an impact on the respondents initial or continued eligibility for access authoriza-tion or employment clearance. A copy of the completed form is sent to the Federal Bureau of Investigation (FBI) where a name check of FBI files is

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In the case of non-U.S. citizen spouses and relatives, j

l appropriate checks at other appropriate Government agencies may also be 1

completed. The results of the completed FBI ar.d other agency checks are J

returned to the NRC Division of Security whereupon a second evaluation /

j determination is iaade, based en any developed information, as to whether it l

has any impact on the respondent's initial or continued eligibility for access authorization or an employment clearance.'

3.

Reduction of Burden Through Information lechnology.

Because the informa-tion is required of individuals and not of corporations or businesses, it is not possible to reduce the burden of 15 minutes per respondent through information technology.

4.

Effort to Identify Duplication.

In a few instances, portions of the needed information might also De contained in other information submitted to the NRC or other federal Agencies.

However, duplication, if any, is slight and the collection of the )nformation by use of the NRC Form 354 is considered the most effective and least burdensome means of obtaining the naeded information.

5.

Effort to Use Similar Infcrmation. No similar information exists. As with other personai information required from an individual applying for or processing an 11RC access authorization, this too must be supplied by the individual. No alternative sources are available.

6.

Effort to Reduce Small Eusiness Burden. The licensees affected by this information collection are not sr.. ell entities or businesses as those terms are used in the Regulatory Flexibility Act.

I 4.

t 7.

Conseguences of Less Frequent Collection. There is ro established report-ting frequer cy or period for submittai of hRC Form 354. This form is

ubmitted only when an applicant marries after completing Personnel i

Security forms; marries af ter receiving an access authorization; or an applicant married to a non-U.S citizen r? quests an NRC access authoriza-I tion.

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8.

Circumstances Which Justify Variation from OMB Guidelines. There is no variation from OMB-Guidelines in this collection of information.

Two copies of NRC Form 354 must be submitted to NRC Division of Security.

The original copy is forwarded to the Federal Bureau of Investigation (FBI). The second copy it retained in the NRC personnel security file until the original is returned to NRC.

The second copy is then destroyed.

9.

Consultations Outside the NRC. No nsultations.

10. Confidentiality of the Information. The information is used for deter-mining initial and continuing eligibility for access authorization. The information is protected from pLL11c disclosure under the Privacy Act of 1974 and is handled in accordance with routine uses specified in the Privacy Act Statement co'ntained on.the form.

11. Justification for Sensitive Questions. The NRC Form 354 requests informa-tion regarding the applicant's or employee's marriage and identifying information regarding his/her spouse and spouse's relatives. Thic information is essential for identification purposes and to permit NRC 4

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to make its determination regarding eligibility for access authorization in accordance with appropriate statutes, executive orders ar.d regulations.

12.

Estimated Annua 112ed Cost to the Federal Government. The annual cost to NRC of receiving and processing the form is estimated at $1,320

.(88 reports x.25/hr x $60).

i 13.

Estimate of Burden. An estimated 15 minutes is required of each of the 88 respondents to complete each NRC Form 354, resulting in a total annual burden to the public of 22 hours2.546296e-4 days <br />0.00611 hours <br />3.637566e-5 weeks <br />8.371e-6 months <br />.

The burden estimates are derived from a review of the present usage of the form by contractors, licensees, and NRC employment appitcants. Therefore, based on this review and a review of the amount of time it takes the affected individuals to complete the form it is our belief that these estimates are considered reasonable.

14 Reason for Changes _in Burden. There has been no change in the burden on the public associated with the completion of NRC Forin 354, since the current OMB approval.

15.

Publication for Statistical Use. None.

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DATA REPORT ON SPOUSE g,gege,orgs 4=ogg,,u,N,fg

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Ment amo evocat.waswinctow oc neot IW5iaWCII0ml - This form shall be completed by any applicent what (e) marries ef ter conplettre the persomet security forms (WC Form 1, *Persomet securf ty ouesticmetre,* or sr 86, acuestionnstre for sensitive Positions); (b) marries ef ter hesire been eranted en accese authoritetton or (gtoyment eteerence; or (c) is married to a ren U.S. citizen and repsts M: eccess J

_suthertretion or eiptoweent eteerence.

1. NAME OF EMPLOYEE OR APPLICANT (Last, First, Middle)

2. OTHER NAMES USED BY EMPLOYEE OR APPLICANT j

l (Malden name and/or other names previously used)

3. EMPLOYMENT (Present assignment)

4. DATE AND PLACE OF MARRIAGE

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5. PRESENT NAME OF SPOUSE (Last, First, Middle)

6. OTHER NAMES USED BY SPOUSE (Maiden name and/or all other names previously used)

7. DATE AND PLACE OF BIRTH OF SPOUSE

8. PRESENT EMPLOYMENT OF SPOUSE (Name and location) i OR LAST PREVIOUS EMPLOYMENT l-

9. PRESENT ADDRESS OF SPOUSE

10. LAST PREVIOUS ADDRESS OF SPOUSE l

11. CITIZENSHIP OF SPOUSE:

U.S.

DUALU (if dual, specif~y countries) i ALIEN IF U.S. CITIZEN, INDICATE WHETHER:

IF ALIEN, INDICATE ALIEN REGIS1.4ATION NO.

(A) BY BIRTH l

(C) BY NATURALIZATIONI 1 (B) DERIVATIVE

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PETITION NO.

(A) OATE OF ENTRY (C) PRESENT CITIZENSHIP DATE DATE j

CERTIFICATE NO.

CERTIFICATE NO.

(B) PORT OF ENTRY

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PLACE PLACE

12. MILITARY SERVICE OF SPOUSE (Past or present)

COUNTRY BRANCH SERI AL t.'O.

F ROM (Yn.)

TO (YR.)

13. SPOUSE'S RELATIVES 1

iParents. divorced spouse or spouses, children, brothers, sisters, stephrothers. steosisters. half brothers. half siste_rs,living or deed)

P RELATION NAME IN FULL 0,ArE7

ADDRESS,

couN"d F in7 s

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14. SIGNATURE OF EMPLOYEE OR APPLICANT DATE N. C FILE NC. (To tie f!;ied in by i Security Of fice)

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p PRIVACY ACT STATEMENT Pursuantto5U.S.C.551a(e)(3),enactedintolawbysection3ofthePrivacy Act of 1974 (Public Law 93-579), the folicwing statement is furnished to individuals who supply information to the Nuclear Regulatory Comnission (NRC) on NRC Form 354. This information is maintained in a system of records designated as NRC-39 and described at 51 Federal Register 33168 (September 18, l

1986, as revised at 52 Federal Register 4427 (February 11,1987).

1.

AUTHORITY.

Sections 145 and 161(1) of the Atomic Energy Act of 1954, as amended (42 U.S.C. 2165 and 2201(1); Executive Orders 10450,10865, and 12356; 40 U.S.C., 318; OMB Circular No. A-130; Federal Personnel Manual l

732 and authorities cited therein.

2.

PRINCIPAL PURPOSE (S),

infomation entered on this fom is used as a i

basis for an investTgation to detemine your initial or continuing I

eligibility for NRC employment, access to Restricted Data, National i

Security Information, or special nuclear material; or for access to NRC buildings or access to Federal automated information systems or j.

data.

i 3.

ROUTINE USES. This information may be disclosed to Federal investigative agencies for the purpose of conducting a security investigation for the l

NRC. The information may also be disclosed to an appropriate Federal.

State or local agency in the event the infomation indicates a violation or potential violation of law and in the course of an administrative or judicial proceeding.

In addition, this information may be transferred to an appropriate Federal, State, and local agency to the extent relevant and necessary for an NRC decision or to an appropriate Federal agency to the extent relevant and necessary for that agency's decision about you.

l 4.

WHETHER DISCLOSURE IS MANDATORY OR VOLUNTARY AND EFFECT ON INDIVIOUAL OF NOT PROVIDING INFORMAil0N.

Disclosure of this information is voluntary; however, if it is not supplied, your clearance processing ray be delayed or your application may not be processed.

5.

SYSTEM MANAGER AND ADDRESS. Director, Division of Security, Office of Administration, U.S. Nuclear Regulatory Conenission, Washington, DC 20555 e

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DATA REPORT ON SPOUSE IS"*.'l0*Ec5EE MEE*UE"~'A'iMI t,"o'#1".f.an'o"c"M'" ~"N,'#,".',ff,"JA

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o IssTrucitoets - This form eheti be completed by any applicent ashoi (a) marries ef ter completing the persorviet securt ty forms (Isac Fors 1,

• Personnel security Questionnette,5* or $f 86, "Questionnelre for sensitive Positions); (b) snerries ef ter hevity been granted on access authoritetton or employment clearance; or (c) is married to e non U.S. citizen and regseste leftC access authorisation ce easitoweent clearance.

1, NAME OF EMPLOYEE OR APPLICANT (Last, First, Middle)

2. OTHER NAMES USED BY EMPLOYEE OR APPLICANT (Maiden nemt and/or other names previously used)

3. EMPLOYMENT (Present assignment)

4. DATE AND PLACE OF MARRIAGE

5. PRESENT NAME OF SPOUSE (Law, First, Midd'.s)

6. OTHER NAMES USED BY SPOUSE (Maiden name and/or all other names prevlously ured)

, DATE AND PLACE OF BIRTH OF SPOUSE

8. PRESENT EMPLOYMENT OF SPOUSE (Name and location)

OR LAST PREVIOUS EMPLOYMENT

9. PRESENT ADDRESS OF SPOUSE

10. LAST PREVIOUS ADDRESS OF SPOUSE ALIEN DUALL J lit dual.5pecifv countries)

11. CITIZENSHIP OF SPOUSE:

U.S.

IF U.S. CITIZEN, INDICATE WHETHER:

IF ALIEN, INDICATE ALIEN REGISTRATION NO.

(A) SY BIRTil I

(C) BY NATURAllZATIONI ]

(B) OERIVATIVE 1

PETITION NO.

(A) DATE OF ENTRY (C) PRESENT CITIZENSHIP DATE DATE CERTIFICATE NO.

CERTIFICATE NO.

(8) PORT OF ENTRY PLACE PLACE

12. MILITARY SERVICE OF SPOUSE (Past or present) l COUNTRY BRANCH SERI AL NO.

FROM (YR.)

TO (YR.)

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13. SPOUSE'S RELATIVES (Psrents, divorced apouse or spouses, children, brothers, sisters, stepbrt,thers, steosisters,belf brothers, hs'i sisters, living or deed)

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RELATION NAME IN FULL 0,^TE7

ADDRESS -

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14,31"iNATURE OF EMPLOYEE OR APPLICANT DATE NRC FILE NO. (To be fitted in by i Security Of fice) r macronu m 1'

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PRIVACY ACT STATEMENT Pursuant to 5 U.S.C. 551a(e)(3), enacted into law by section 3 of the Privacy Act of 1974 (Public Law 93-579), the following statement is furnished to individuals who supply information to the Nuclear Regulatory Comission (NRC) on NRC Form 354, ' This information is maintained in a system of records designated as NRC-39 and described at 51 Federal Register 33168 (September 18, 1986, as revised at 52 Federal Reaf ster 4427 (February 11,1987).

1.

AUTHORITY.

Sections 145 and 161(1) of the Atomic Energy Act of 1954, as amended (42 U.S.C. 2165 and 2201(1); Executive Orders 10450, 10865, and 12356; 40 U.S.C., 318; OMB Circular No. A-130; Federal Personnel Manual 732 and authorities cited therein.

2.

PRINCIPAL PURPOSE (S).

Infonnation entered on this form is used as a basis for an investsgation to determine your initial or continuing eligibility for NRC employment, access to Restricted Data, National Security Infonnation, or special nuclear material; or for access to q

NRC-buildings or access to Federal automated infonnation systems or data.

3.

ROUTINE USES. This information may be disclosed to Federal investigative agencies for the purpose of conducting a security investigation for the NRC. The information may also be disclosed to an appropriate Federal,

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State or local ageacy in the event the infonnation indicates a violation or potential violation of law and in the course of an administrative or judicial proceeding.

In addition, this infonnation may be transferred to an appropriate Federal, State, and local agency to the extent relevant i

and necessary for an NRC decision or to an appropriate Federal agency to the extent relevant and necessary for that agency's decision about you.

4.

WHETHER DISCLOSURE IS MANDATORY OR VOLUNTAP.Y AND EFFECT ON INDIVIDUAL OF NJT PROVIDING INFORMATION. Disclosure of this information is voluntary; however, if it is not supplied, your clearance processing may be delayed or your application may not be processed.

j 5.

SYSTEM MANAGER AND ADDRESS. Director, Division of Security, Office of Administration U.S. Nuclear Regulatory Comission, Washington, DC 2055S l

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