ML20039C924

Request for OMB Review & Supporting Statement Re NRC Form 443, Confidential Statement of Employment & Financial Interests, 10CFR0.735-28.Estimated Respondent Burden Is 200-h

ML20039C924
Person / Time
Issue date:	12/11/1981
From:	Donoghue D, Scott R NRC OFFICE OF ADMINISTRATION (ADM)
To:
Shared Package
ML20039C918	List: ML20039C917 ML20039C921 ML20039C924
References
NUDOCS 8112310106
Download: ML20039C924 (6)

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REEUEST FHR CMB REVIEW (Und:r th2 Pap:rwork R: duction Act cnd Extcutive Ord:r 12291)

Imp rt:nt - Read instructions (SF-83A) before completing this Office of Information and Regulatory Affairs form. Submit the requirednumber of copies of SF-83.together Office of Management and Budget with tha material for which review is requested to:

Washington. D.C. 20503

1. Depirtment/ Agency and Bureau / Office originating request

3. Name(s) and telephone number (s) of person (s) who can best answer questions regardin U.S, Nuclear Regulatory Commission 1, Rothschild (202) g request 634-1465 2.6-digit Agency / Bureau number (firstpart of 11-digit Treasury 4.3-digit functional code {Iastpart of 11-digit Treasury Account Account No.)

No.)

3 1

0 2 0 0

2 7

6

5. Tatis of Informatson Col\\ection or Rutemaking

'C. Is this a rutemaking submission under Section 3504fhj ot P.L 96-511 ? (Check one)

Confidential Statement of Employment and Financial Interests, 17 No (Section 3507 submission) 10 CFR 0.735-28 20 Yes.NPRM. Expected date of publication:

6. A. Is any sntormation coIIection (reporting or recordkeeping) 3 O Yes, final rute. Exrected date of publucatnon:

involved? (Check one)

Etfective date:

1 (X Yes and proposal is attached for review D. At what phase of rulemaking is this submission made?

2 0 Yes but proposalis not attached - skip to question D.

3 O No - skip to Question D.

1 [X Not applicable B. Ars the respondents pnmarily educationalagencies or 20 Maior rule.at NPRM stage institutions ofis the purpose related to Federaleducation 30 Major Final rufe for which no NPRM was pubbshed programs ?

4 O Major Final rule, after pubhcation of NPRM

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O Ycs IX No 5 O Nonmajor rule.at NPRM stage 6 O Nonmaior rule. at Final stage COMPLETE SHADED PORTION IFINFORMATION COLLECTION PROPOS ALIS ATTACHED

7. Currsnt (or former) OMB Number

8. Requested

12. Agency report form number (s)

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3150-0025 Expiration Date NRC 443

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Expiration Date

13. Are respondents only Federal a;}encies?

1/31/85 1/31/82 XJ No O Yes O. Is proposed information collection listed in

14. Type of request (Check one) tha information collection budget?

g)Yes O No 1 O' prehminary plan-

.10. Will this pruposed information collection 2 O _ new inot previousty approved or expired more than 6 months Iago) causa the agency to exceed its information coll:ction budget allowance? (If yes. attach O'Yes

(% No 3 0 revision amsndment request from agency head.)

4 O estension (adiustment to burden only)

, 11. Number of report forms submitted for approval 5 )b extension (no change)

One s O reinstatement (expired wrrhin s months

) 15.

16. Classification nf Change in Burden (explain in supporting statement) i l

e Appros mate sire of No.of Responses No.of Reporting Hours Cost to the Public l o sinof sample N/A e Ininventory 200 200 5

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e.E.nm.ieonumbe,og

b. As propose"d 200 200 s

r:sooneents '

200

c. Difference (b-a)

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recorneepers per year n.

n i

anahn d Meme WM abW H Md

d. Aeports annuaHy by each respondent t, rem 2ss 1

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Adjustments l

I.Te'm *""",*'r's'e'E ""'

200

d. Correetion7 error [.-1 i

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e. Correction-reestimate [i i

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< f. Estim:ted everage 4

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' b numtwrof hours 1

f. Change in use

{ pere;sponse pY Program changes ;

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• g E9 mated totalhours of ennr1t>urdenin

g. increase

+

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• • • ' 's"o,' 15 0 200

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h. Decrease 8112310106 811214 Standard Form 83 (Rev. 3-81)

PDR ORG EUSOMB For Use Beginning 4/1/81 PDR

.17. Abstract-Nnds cnd Usis (50 words ofljss)

Provides basic data for potential agency employees and/or consultants to preclude any potential conflict of interest.

18. Ral; tid report form (s) (give OMB number (s),IRCN(s),

20. Catalog of Federal Domestic Assistance Program Number intirnil agency report form number (s) or symbol (s)),

N/A N/A 21.Small business or organization O Yes ID No 19.Typ2 of affected public (Check as manyas apply)

22. Type of activity of affected public-in04te 3-digit Standard 1XJ individuals orhouseholds industrial Classification (SIC) code (s) (up to 10) - if over 2 O state orlocalgovernments 10, check O Multiple or O All 3 O 1:rms 4 O businesses or otherinstitutions (except farms)

I O S

23. Brist description of affected public le g. "retailgrocery stores."" State education agencies."" households in 50 larges't SMSX s")

NRC consultants and potential employees

24. Purpose (Check as many as apply. It more than one, indicate

26. Collection method (Check as many as apply)^ '

prtdominant by an asterisk) 1D mailself-administered t O apolication for benefits 2 O 'other self-administered 2 O program evaluation 30 telephoneinterview

~3' O general purpose statistics 40 personalinterview 4 tX r@gulatory or compliance 50 recordkeeping requirement:

a_

5 O program planning or management Required retention period:

' years. (

,_,2 6 O rssearch 6 O other-describe:

- 25. Frequency of Use

27. Collection agent (Check one) 1 O Nonrecurring 1D requesting Department / Agency Recurring (check as many as apply) 2 O other FederalDepartment/ Agency 2 D on occasion 60 semiannually 3 0 private contractor 3 O weekly 70 annually 4 O recordkeeping requirement _

4 O monthly 80 biennially 5 O other-describe:

5 0 quarterly 90 other-describe:

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

rulemaking-indicate statute, regulation, judicial decree.

(11yes, explain basis for pledge stc.

in supporting statement.)

LX Yes.,) No:

Encutive Order 11222, May 8,1965 31 Will the proposed information collection create a new or become part of an existing Privacy Act system of records?

29. Respondent's obligation to reply (Check as many as apply)

(11 yes. attach Federal Register notice or proposed draft of 1 O voluntary notice.)

O Yes K No 2 @ r: quired to obtain or retain benefit

32. Cost to Federal Government of 3., mandatory-cite statute.not CFR (attach copy of information collection or rulemaking S16.000 l,

statutory authority) l l

COMPLETE ITEMS 33 THRU 35 0NLY lF RULEMAKING SUBMISSION 33.Comphance costs to the public

34. Is there a regulatory impact

35. ls there a statutory or Judicial analysis attached?

deadline affecting issuance?

l s

O Yes' O No O Yes. Enter date:

O No CERT.'lC ATION BY AUTHORIZED OFFICI ALS SUBMITTING REOUEST-We certify that the information collection or rulemaking submitted for r ;vi;w is n:cessary for the proper performance of the agency's functions, that the proposal represents the minimum pubhc burden and Federal cost

, c nsist:nt with need. and is consistent with applicable OMB and agency policy directives. Signature and title of:

APPAOYING ECLICY OFFICIAL FoA AGENCY oATE susuiTTING OFFICIAL oATE olQU N

W T P)

Daniel J. Donog'ue R. 't ph IP

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SUPPORTING STATEMENT FOR NRC Form 443, Confidential Statement of Employment and Financial Interests 10 CFR Part 0.735-28 Justification Paragraph 0.735-28(a) of 10 CFR Part 0 provides that certain NRC employees and all NRC consultants, advisers, and experts (defined as "Special Government Employee", -10 CFR 0.735-4(e)) shall submit statements of employ-ment and financial interests prepared in accordance with 5 0.735-28(c). The information is furnished on NRC Form 443.

Statements by consultants are subniitted prior to appointments. The purpose of requiring prospective consultants and advisers to complete NRC Form 443 is to comply with the require-ments of Executive Order 11222, May 8,1965, with respect to possible conflicts of interest.

In addition, the first portion provides hiring officials with a basis for determining the qualifications of the consultant, adviser, or expert and for setting the appropriate rate of compensation.

NRC Form 443 provides the staff with (a) a resume of the individual's employment and professional attainments, and (b) a confidential record of financial interests for use in judging possible conflicts of interests.

This information is necessary if the individual's qualifications and potential conflicts of interest are to be assessed.

There is no source for the required information other than the individual consultants and advisers.

Confidentiality is required by E.0.11222.

Description of the survey plan All potential "Special Government Employees" will be part of the respondent universe.

Tabulation and publication plans Information collected will not be published.

Time schedule for data collection and publication Information collected will be utilized as part of the normal personnel selection process which normally takes no longer than two months.

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i 2-Consultations outside the agency There were no consultations held outside the agency.

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Estimation of compliance burden Approximately 200 statements are filed annually.

Experience shows that each statement takes the individual about 1 hour1.157407e-5 days <br />2.777778e-4 hours <br />1.653439e-6 weeks <br />3.805e-7 months <br /> to prepare. The total annual burden for all respondents is about 200 hours0.00231 days <br />0.0556 hours <br />3.306878e-4 weeks <br />7.61e-5 months <br />.

Estimate of cost to the Federal Government Cost to the Federal Government is $16,000 which covers 400 staff hours of effort which are required to review, investigate, and process the completed forms.

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Enclosures:

NRC Form 443 b

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2. BIRTH DATE

1. N AM E (First, middle initial, last)

4. TELEPHON E:

3. HOME ADDRESS (Street. City State, ZIP Code)

Home:

Business;

6. COLLEGE OR UNIVERSITY

7. DATES ATTENDED

8. DEGREE

9. YEAR

5. Citaen of U.S. A.

O YES O NO

10. a. If you are a U.S. Civil Service annustant, what is your monthly annuity ? S..................................-..............

b. Are you a retired officer of a resplar component of theUniformed Services? O Yes O No if yes, contact your Service for information concerning any reduction in retired military pay made necessary by receipt of Feoeral civilian pay.

11. Employment during last 10 years (includino consultantshiosL List present position first - you Mnclude only the ones reined to your regular profession.IList current Federal pos.tions in aern 44. ae.ony ///,.W/

EMPLOYER ADDRESS l POSITION HELDSALARY OR FEE j DATES

12. OTHER FEDERAL GOVERNMENT EMPLOYMENT. List all other Federal departments and agencies bniAiding otner NHC othces) in which you are serving or expect to serve as consultant, adviser, expert, or part. time, or intermittent employee during the next 365 days. If none, write **None."

ESTIMATED APPOINTMENT PE RIOD AGENCY AND LOCATION TITLE OR KIND OF POSITION NO OF FROM -l TO DAYS I

13. List your significant professional society memberships, honors, and fellowships received; important publications, licenses, and other special quahfications:

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FoR USE ev NRC

18. DETERMINATION BY APPROPRIATE GFERAT.JOFFICIAL:

A I have reviewed the statement of the subject individual in relation to his/her proposed duties and responsibilities and find:

O no contiict o apparent conflict of interest.

O the following question (s) which require resolution; The following steps have been taken to resolve the Question (s) referred to above:

Unqer applicable law and NRC regulations,the individual is not to prticipate in any particular matter et will have a direct and predictable effect upon the financial interests of a business entity, including nonprofit organization or, education institution, by which he/she is employed or with which he/she is negotiating for or has any arrangement concerning prospective em-ployment, or to which he/she renders consultant services, or in which he/she has a financial interest not exempted under Par 21(c)), of NRC Anpendix 4124. However,he/she need not be precluded from rendering general advice in situations where no prefer-ence or advantag? over others might be gained by any particular person or organization, (Date)

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19 @ termination oy Counseior (or Deputy Counsep i have reviewed the statement of the subject individual and the operating o' facial's determination above ead find:

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O no evidence of confiict or apparent conflict of interest.

O the foitoaing auestion(s) which required resolution:

The following steps have been taken to resolve the Questiorts) referred to above:

(Date)

(Signature) e The information to be furnished in items 15-16 of this statementis required by E xecutive Order 11222 and the regulations of the of Personnel Management and the Nuclear Regulatory Commission issued thereunder, and may not be disclosed by the NRC ex accordance with the provisions of NRC Manual Chapter 4124 or as the Office of Personnel Management or the Nuclear Regulatory Commission enav determine for good cause shown.

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