ML20033A220

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Request for OMB Review & Supporting Statement Re Form 354, Data Rept on Spouse.Estimated Respondent Burden Is 6-h
ML20033A220
Person / Time
Issue date: 11/10/1981
From:
NRC OFFICE OF ADMINISTRATION (ADM)
To:
Shared Package
ML20033A219 List:
References
NUDOCS 8111240928
Download: ML20033A220 (5)
v • d • e


Text

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RE2UEST FOR UMB REVIEW (Und:rthe P;perwork R: duction Actcnd Ex:cutiv2 Order 12291)

Import:nt - Read instructions (SF-83 A) before completing this Oif ce of information and Fiegufatory Affatts form. Submit the required number of cop,es of SF-83,together Ottsce of Management and Buaget with the material for which review is requested to:

Washington. D C. 20503

1. Dep;rtment/ Agency and Bureau / Office originating request -
3. Name(s) and telephone number (s) of person (s) who can best answer questions regarding request U S. Nuclear Regulatory Comission

~ Carol Rossomondo (301) 427-4524 2.6-21 git Agency / Bureau number (Isrstpart of t 1-digit Treasury

4. 3-dig'st functional code (lastpart of 11-digst Treasury Account Account No.)

No.)

_3_.

l

_0_ -.2.

_D

_0_

.2.

7 ft 5 Tstle of Informatson Collection or Rulemaknng C. Is this a rulemaksng suDmission under Section 3504thi ot P L. 96 5117 (Check one)

Data Report on Spouse, NRC Form 354 i q No ts.ciion 3sD7 uemission) 20 Yes.NPPM. Expected date of pubhcation:

6. A. Is any snlorma tson collection (reporting or recordkeeping) 30 Yes tanaltute. Expected date of puchcatnon:

involved? (Check ona)

Effective date:

1 Q Yes and proposal es attached for review D. At what : base of rulemaking is this submission made?

2 O Yes but prcposat is not attached - skip to Question D 3 C No - skip to ouestion D.

1 CX Not applicable B. Ar3 the respondents pnmanly educationalagencies or 2 0 Maior rule.at NPRM stage institutions oris the purpose related to federaleducation 3 O Maior Final rule *or which no NPRM was pu%hshed programs ?

4 O Major Fatal rule. after pubhcation of NPRM O Yes R No 5 O Nonmajor rule,at NPRM stage 6 CJ Nonmajor rule.at Final atage -

COMPLETE SHADED PORTION IFINFOR8'ATION COLLECTION PROPOsALIS ATTACHED 7.Curr:nt (or former) OMB Number

8. Requested
12. Agency report form number (s) 3150-0026 NRC Fofm 354 Expiration Date
13. Are respondents only Federal agencies?

2/28/82 2/28/85 O Yes fyNo 9.13 proposed inf ormation collection listed in

14. Type of request (Check one) th*e Information collection budget?

2 Yes O No' 1 O prehminaryplan

10. Will this proposed mformation collection 2 O new (not previously approved or expued more than 6 months ccuse the agency to exceed its information ago) -

ctifiction budget allowance? (if yes. attach O Yes R No 3 0 revision cm:ndment request from a gency head.)

4 0 extension (adjustment to burden only)

11. Number of report forms submitted for approval 5 g extension (no chat'ge)

One (1) 6 D rems'atement (*"p' red "'h." 6 mon'h*1 15.

16.Ctassitscation of Change in Burden (exp! sin in supporting statement)

,O ADorosimate St2 eof N/A No.of Responses No of Reportmg Hours Cost to the Public b soof sempie N/A

a. In invmory s

C Etldet.ted number of b As proposted r2spondents or record hucers pe: yes'

c. Difference (b-a) 34 e Reports ann arry by each Explanation of difference (indicate as many as apply) u respondent rerem Ps)

I Adjustments

',"Es 'r'sg; d Correction-error i

i i$

24

e. Correction-reestiaate i i

iS f Est* mated antage

    • "b'""*"
f. Change in use i

i i5 per en-w jf4

~ g Latimattitotst hours f,*c]",'j,b8'" *

g. Increase

+

+

+$

- brem 153m 15r1 6

h.Decre se

-S.

F11124092 811110 standard Form a3 (Re > 3-8;)

J PDR ORO' EUSOMB For Use Beginning 4/1/81 PDR

~~

~~~~

7. Abs.trf et-Nxds cnd Uses (50 words ort;ss)

Infcrmation conc:rning alien spous:s.of NRC applicants, alien spouses of contractors, 'and spouses cf contractors marri d after granting cf access is required to meet basic security requirements.

18 R;tated report formis) (give OMB number (s). IRCN(s).

20. Catalog ot Federal Domest.c Assistance Program Number ~

mt;rnalagency report form number (s) or symbol (s))

e fUA l21.Smail bcsiness or organization O Yes

  • g)( No 19 Type of affected pubhc (Check as saanyas appfy)
22. Type of activity of affected public-indicate 3-digit Standard Industnal Classdication (SIC) code (s) (up to 101 - if over WX Individva!s or households 10, check O Multiple ~ or - Q All 2 O state orlocalgovernments 3 O farms 4 O businesses or otherinstitutions (encept farms)

_g_ _g_._}_

23. Brief description of affected public le g,"retait grocery stores," State eds'ation agencies."" households las 50 largest SMSA s")

NRC applicants, contractors, and licensees 24 Purpose (Check as manyas apply. If anore than one, ondicate

26. Collection method (Check as many as apply) ?

przdominant by an asterisk) 19 mailself administered 1 O application for benefits 20 other self-administered 2 O program evaluation '

30 telephoneinterview.

't O general purpose statistics 40 personalinterview 4 g regulatory or compliance 50 recordkeeping requirement:

5 O program planning or management Required retention period:

years

  • 6 O research 6 O other-describe:

25.Fr;quencyof Use.

27. Collection agent (Check one) 1 O Nontecurring.

IX3 requesting Department / Agency Recurring (check as manyas apply) 2 O other Federat Department / Agency 2J)(on occasion 60 semiannually 3 0 private contractor 3 O weekly 70 annually 4 O recordkeeping requirement 4 0 tr'onthly 80 biennially 5 O other-describe; 5 O quarterly 90 other-describe:

28 Authority for agency forinformation collection or 30.Do you promise confidentiality?

a rulimaking-indicate statute, regulation. judicial decree.

(If yes. explain basis for pledge C1c.

.in supporting statement.)

p Yes O No Atoxic Energy Act of 1954 31.Will the proposed infore ation collection create a new or become part of an existing Privacy Act system of records? -

29. R:spondent's obligation to rt: ply (Check as many as apply)

(l' res. attach Federal Register notice or proposed draft of 1

1D voluntary notice.).

iYes X'No 2 O required to obtain or retain benefit

32. Cost to Federal Government of 3 7 mandatory-cite statute. not CFR (attach copy of information collection or rulemaking s76_ OG statutory authority)

COMPLETE ITEMS 33 THRU 35 ONLY lF RULEM AKING SUBMISSION

33. Ccmpliance costs to the public

~ 34. ls there a regulatory impact

35. Is there a stettutory or judicial analysis attached?

ceadline aflecting issuance')

s.,

O Yes O No O Yes. Enter date O No CET.TIFICATION BY AUTHORIZED OFFICI ALS SUBMITTING REQUEST-We certify that the information co1ection or rulemaking suomitted for review b necessary for the proper performance of the agency's f unctions, that the reposal represents the minimum public burden and Federal cost con!i; tent with need, and is consistent with apphcable OMB and agency pokey dire

  • t.ves. Signature and title of.

APPROVING POLICY OFFaciAL FOR AGENCY DATE SUBMITTING oFFscsAL OATE

?

SUFFORTING STATEMENT 4

FOR 1

t NRC FORM 354

" Data Report on Spouse" Justification Section 145 of the-Atomic Energy Act (AEA) of 1954, as amended, requires, before an individual can be granted access to Restricted Data (RD), an investigation I

and report onLthe individuales character associations and loyalty and a determina-tion that permitting such a person to have access to RD will not ' endanger the common defense and security.

The basic security standard of E.O.10450, " Security Requirements for Federal.

l-Employment," for employment, or retention of an individual in a sensitive position, is that such employment or retention is " clearly consistent with the i

interests of the national security." Executive Order.10865, " Safeguarding Classified Information Within Industry," likewise permits the "... head of a department or his designee..." to grant access authorizations for industrial employees (NRC contractors) "...only upon finding that it is clearly consistent l

with the national interest to do so."

L 10 CFR Part 10 " Criteria and Procedures for Determining Eligibility for Access to Restricted Data or National Security Information," provides criteria to assist in making this-determination.

A substantial' portion of the criteria applies to the individual and his spouse.

In order for~HRC to implement this retponsibility it is pertinent, from a security standpoint,.that NRC receive information concerning (1) alien spouses of NRC applicants'-(2) alien spouses of NRC contractor and licensee empipyees pending NRC access authorization -

processing; (3) NRC applicants, contractor or licensee employees who marry i

r l

after applying for NRC access authorization; and (4); spouses of NRC contractorf and licensee employees who marry after having been granted NRC access -

authorization.

The information supplied identifies the respondent, his/her spouse, spouse's L

citizenship, and data on the spouse's relatives..This information permits an initial security determination by the NRC Division of Security as to whether-1 or not any information on the form has ah impact on the respondent's initial or continued eligibility for access-authorization.

A copy of the completed form is sent to the Federal Bureau of Investigation (FBI) where a name check on FBI files is completed.

In the case of alien speuses and relatives, appropriate-4 checks at other appropriate Government agencies are also completed..The results

'of the completed FBI and other agency checks are returned to the NRC Division of Security whereupon a second evaluation / determination.is made, based on any -

developed information, as to whether it has any impact on the respondent's initial or continued eligibility for access authorization.

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. f, 2-As with other personal information required from an individual applying for or possessing an NRC access authorization, this too must be supplied by the individual. No alternative sources are available.

-Description of the survey plan Not applicable.

Tabulation and publication plans Information collected will not be published.

Time schedule for data collection and publication Not applicable.

1 Consultations outside the agency No consultations have taken place since the last clearance approval.

Estimation of compliance burden Experience has shown that the burden associated with filling out the form is estimated to be 15 minutes.

Approximately 24 forms are filled out annually by individuals who are not NRC employees.

24 X 15 minutes = 6 hours6.944444e-5 days <br />0.00167 hours <br />9.920635e-6 weeks <br />2.283e-6 months <br />.

Estimate of cost to the Federal Government The staff time for NRC is approximately 15 minutes per form,10 minutes for processing by a GG-6 and 5 minutes for receiving at a GG-7 level.

Costs:

l A.

Processing-(initial submission) 10 minutes X 24 X $12.00 per hour =

$48.00.

B.

Receiving (review FBI evaluation) 5 minutes X 24 X $14.00 per hour =

$28.00.

C.

Forms reproduction, Negligible. Total Cost $76.00

Enclosure:

NRC Form 354

.. ~~

e corJ N-.C Fa rm 354 Approved by W f

M '

UNITED STATES NUCLEAR REGULATORY COMM:SSION M

kr -

DATA REPORT ON SPOUSE

^

INSTRUCTIONS - This form shall be completed by: (a) persons who marry atter the time they submlt FoTiRldC71,

Personnel Security Ouestionnaire," as applicants for security clearance, or access authorization (b) applicants for clearance or access authorization who are married to aliens.

1. NAME OF EMPLOYEE OR APPLICdNT (Last, First, Middle)
2. OTHER NAMES USED BY EMPLOYEE OR APPLICANT (Maiden name and/or other names previously used)
3. EMPLOYMENT (Present assignment)
4. DATE AND PLACE OF MARRIAGE
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)

OR LAST PREVIOUS EMPLOYMENT

9. PRESENT ADDRESS OF SPOUSE
10. LAST PREVIOUS ADDRESS OF SPOUSE
11. CITIZENSHIP OF SPOUSE:

U.S.

[]

ALIEN []

IF U.S. CITIZEN, INDICATE WHETHER:

IF ALIEN, INDICATE ALIEN REGISTRATION NO.

(A) BY BIRTH O

(C) BY NATURALIZATION O (B) DERIVATIVEO PETITION NO-(A) DATE OF ENTRY (C) PRESENT CITIZENSHIP DATE DATE CERTIFICATE NO.

CERTIFICATE NO.

(B) PORT OF ENTRY PLACE PLACE

12. MILITARY SERVICE OF SPOUSE (Past or present)

COUNTRY SERIAL NO.

BRANCH FROM (YR.)

TO (YR.)

13. SPOUSE'S RELATIVES)

(Parents divorced spouse or spouses. children, brothers. sisters, sterbrothers. stepsistees. half brothers, half sisters. living or dead)

RELATION NAME IN FULL DATE OF ADDRESS COUNTRY OF PRESENT BIRTH BIRTH CITIZENSHIP se h

14. SIGNATURE OF EMPLOYEE OR APPLICANT DATE NRC FILE NO. (To be filled in by 4

Security Office) l N AC kOpv 3%4

' y f t>4t'

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