ML20039C971

Request for OMB Review & Supporting Statement Re NRC Form 237, Request for Access Authorization. Estimated Respondent Burden Is 170-h Annually

ML20039C971
Person / Time
Issue date:	12/14/1981
From:	Donoghue D, Scott R NRC OFFICE OF ADMINISTRATION (ADM)
To:
Shared Package
ML20039C967	List: ML20039C966 ML20039C969 ML20039C971
References
NUDOCS 8112310158
Download: ML20039C971 (6)

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BEZUEST FER OMB REVIEW (Und:t thy Pap rwork R: duction Act and Ex:cutiv2 Ord:t 12291)

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

Washington. D.C. 20503 1.Dep2rtment/ 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 Commission J. Dunleavy (301) 427-4001 2.6-digit Agency / Bureau number (firstpart of 11-digit Treasury

4. 3-dig \\t functional code (last part of 11-digit Treasury Account Account No.)

No.)

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3 I OLLA 2

7 6

5. T.tts of Information Collection or Rutemaking 1

C. Is this a rulemaking submission under Section 3504 fh) of P L. 96-5117 (Check one)

Request for Access Authorizat_ ion i q No (section 3sor submission) 2 O Yes. NPRM. Expected date of pubhcation:

6. A.Is anyinformation collection (reporting orrecordkeeping) 3 0 Yes finalrule. Expected date of pubhcation:

involved? (Check one)

Effective date:

1 IX Yes and proposat is attached for review D. At what phase of rulemaking is this submission made?

one) 2 0 Yes but proposalis not attached - skip to Question O.

3 O No - skip to Question D.

1)Q Not apphcable B. Ara the respondents pnmartly educational agenclea or 2 0 Major rule,at NPRM stage institutions oris the purpose related to Federal education 3 0 Maior Fun.nt rule for which no NPRM was published programs ?

4 O Major Final rule. after pubhcation of NPRM O Yes

[X No S O Nonmajor rule, at NPRM stage 6 0 Nonmajor rule, at Final stage COMPLETE SHADED PORTION IF INFORM ATION COLLECTION PftOP:sSAL IS ATTACHED

7. Current (or former) OM B Number

8. Requested..

12. Agency report forfn number (s)__ _ u.

__a Expiration Date.

1 3150-0050 NRC Form 237 i

EMation Date

13. Are resporidents only Ferferal agencies?.

12/31/81 12/31/84 O Yes Jp' No j

9. ls proposed information collection listed in

14. Type of request (Check one)

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thT)information collection budget?

% Yes ~ O' No 1 O prehminary plan i

10. Wi!\\ this proposed information collection 2 O new (not previousty epproved or expired more shan 6 months

' ego) cause the agency to exceed its information 3.O' revision collection budget allowance? (if yes, attach O 'YeI)(X No cm1ndment request from agencyhead.)

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4 'g extension' fadiustment to burden only)

11. Number of report forms submitted for approval 5 0 extension (no change) 6 0 resnstatement (espired within 6 months) -

One 15.

16. Ctassification of Change in Burden (explain in supporting statement) o Appronmate. sire of unverse hesaep.e)

N/A No of Responses. No.of Reportino Hours Cost to the Pubhc 8

{ b sirsof sampie N/A

a. in inventory 6.200 620

c. Estimited number of

b. As proposed -

1.100 l'10 8

5 respondents or h

1,700

c. Dif ference (b.-d recorneepers per vear 4.500 450

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Exp!anation of difference (indicate as many as appty) d Reports annually by each t r: spondent (etem 25)

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Adjustments

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d. Corteetionkrror (,i i

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e. Correction-ree' stir 5ateD 4,500 450 iS

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170

h. Decrease

-S 8112310150 011215 PDR ORG EUSOMB Standard Form 83 tRev.3 81)

PDR For use Beginning 4ti r81

97. Abstfact-N Cds cnd Us:s (50 words cr1:ss)

Provides basic data for use in revies o,f application for a security clearance.

.18. Rst:tsd report f orm(s) (give OMB number (s), lRCN(s),

20. Catalog ot Federal Dumeste Assistance Program Number int:rnal a gency report form number (sj or symbol (s))_., "

21.Smallbusinessor rhanization 3150-0046 3150-0048 O Yes RNo 3150-0062 19.Typa of affected public (Check as manyas apply)

22. Type of activity of affected public-indicate 3-digit Standard

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18 individuals othouseholds 10, check O Multiple os O All 2 O state orlocalgovernments 3 0 f:rms 4 0 businesses or otherinstitutions (ixcept farms)

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23. Brist dsscription ' t affected public le G.." retail grocery stores."" State education agencies,"" households in 50Isvgest SMSA s")

b Non-government individuals requesting securityl clearance.

26. Collection method (Check as many as apply).5.n %

24. Purpose (Check as many as apply. If more than one. indicate r

?1hmailself-administered ^b5$VLY$$ ON

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pr: dominant by an asterisk)

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Sh*,[. M Y 9 3[.-

1 O application for benefits

'2O otherself-adrninistere3M

.i 2 O program evaluation 30; telephone interview 3 0 gsneralpurpose statistics

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4R rsgulatory or compliance 50 recordkeeping requirementW_ ;_

5 0 program planning or management

] [ Re} quired setentio.n,poriod}

'yearsb::;,;h2 6 0 rssearch 6 0 other-describei 25.Frs.qusney of Use

27. Collection agent (Check one) ' H -

c-1 O Nonrecurring 1 Xi requesting Department / Agency ~ * #,@OF.-i

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Rrcurring (check as manyas apply) 2 O other Federal Department /A'gency : '-

2 Jg onoccasion 6O semiannually 3 O private contractor'I ' ;([g 3 O weekly 70 annually 4 O'recordkeeping regul_rement.

i_,__,,_,,,,,

' 5 0 other-describe:

4 r] monthly 80 biennially 5 0 quarterly 90 other-describe:

28. Authority for agency forinformation collection or 30.Do you prornise confidentiality?7 y;. -

ruismaking-indicate statute, regulation, judicial decree, (If yes, erplain basis forpledge gaw- -.,

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in supporting statement.).

c,0.Y.es..QNoL 10 CFR 25 10 CFR 11 31.Will the proposed information collection crea'e a new at

. Atomic Energy Act of 1954 become part of an existing Privacy Act system of reccrds?

29. Raspondent's obligation to repty (Check as manyas apply)

(If yes. attach FederalRegister notice orproposed draft of 1 O voluntary notice.)

O_Yes, [5 No -i 2 O rsquired to obtain or retain benefit

32. Cost to Federal Government of 3 8 mandatory-cite statute,not CFR (attach copy of Information collection or rulemaking $41040 '

statutory authority)

COMPLETE ITEMS 33 THRU 35 ONLY IF RULEM AKING SUBMISSION

33. Compliance costs to the public

! 34. ls there a' regulatory impact

35. ls there a statutory or judicial analysis attached?

deadline affecting issuance 7' s

0 Yes O No O Yes. Enter date:

s O No o+

CERTIFIC ATION BY AUTHORIZED OFFICI ALS SUBMITTING REQUEST-We certify that the information collection or rutemaking submilled for r;vi wis n:cessary for the proper performance of the agency's functions,that the proposalrepresents the minimum public burden and Federalcost Consist:nt with need, and is consistent with applicable OMB and agency policy directives. Signature and title of:

g SususTT:NG oFFCIA6 oATE APPROVING POLICY OFF8CI AL FoR AGENCY oATE g.

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SUPPORTING STATEMENT FOR NRC Form 237 Roquest for Access Authorization s

Justification NRC Form 237 is used as an administrative tool by NRC contractors, licensees and other government agencies for requesting NRC access authorizations. A licensee, contractor official, or a security officer will normally prepare the form for their employees and contractors. The signature of the authorizing official (the security officer) must appear on the form as well as the approval of the NRC sponsoring official. The information on the form will be reviewed by-NRC Division of Security personnel. Any questions relative to the validity or appropriateness of the request may be referred to the NRC offices exercising licensing or regulatory authority over the licensee, contractor or government agency before processing the access authorization request.

In addition to the signatures mentioned above, the form contains the name of the subject of the request, the level of access authorization requested, the subject's date of birth, other appropriate remarks (i.e., previous clearance history), and an identification of enclosures (i.e., completed personnel security packet).

A personnel security packet received without this form or without the authorizing official's signature may Tesult in no action being taken on the access authorization request.

The use of this form fulfills an administrative requirement by assuring that the licensee, contractor or government agency has determined that the subject of the request requires access to classified matter, and that the licensee, contractor or goverr. ment agency is sponsoring the subject for an NRC access authorization. Adr.iinistratively, such a condition would be burdensome to NRC and may result in individuals being processed for access a;.thorizations when the need does not exist. This administrative requirement governing submis-sions for access authorizations benefits NRC and the Federal Government by affording some efficiency and control over the personnel access authorization procedures contained in 10 CFR Part 25 and 10 CFR 11.

The completed form will be reviewed by NRC, Division of Security personnel.

Questions regarding the request, may be referred as indicated above. The fonn will be retained as a part of the subject's official personnel security record.

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, There is no source for the required information other than respondents.

, Description of survey plan E

All individuals requiring NRC access to classified information are required to submit an NRC Fonn 237.

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Tabulation and publication plans Information received will not be published.

Time schedule for data collection and p6blication The form will be processed within 24 hours2.777778e-4 days <br />0.00667 hours <br />3.968254e-5 weeks <br />9.132e-6 months <br /> of receipt and will be retained as partsof the respondents official NRC personnel security record.

Consultations outside the agency No official consultatio_ns outside the NRC were held since the last clearance submission.

Estimation of' compliance burden Current projection's reflect that an average of 1,700 individuals will complete this form.

It is estimated that each respondent will need approximately 6 minutes to complete this form. Therefore the total burden is approximately 1,700 times 6 minutes or 170 hours0.00197 days <br />0.0472 hours <br />2.810847e-4 weeks <br />6.4685e-5 months <br />.

Cost to Government Costs include printing, mailing, and review of the completed form. The administrative review conducted by a GG-6, Division of Security, takes 3 minutes per form for a total of 85 hours9.837963e-4 days <br />0.0236 hours <br />1.405423e-4 weeks <br />3.23425e-5 months <br />.

The review and approval by the NRC sponsoring official takes 30 minutes for a total of 850 hours0.00984 days <br />0.236 hours <br />0.00141 weeks <br />3.23425e-4 months <br />. Therefore, the total NRC review and approval process takes 935 hours0.0108 days <br />0.26 hours <br />0.00155 weeks <br />3.557675e-4 months <br /> annually.

g Costs are therefore:

A.

Printing 50.00-B.

Mailing-340.00 C.

Review and approval

$35,020.00 TOTAL

$35,410.00

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'i NRC Form-237

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NRC eocu 237 U.S. NUCLEAR REIULATORY COMMISSION WASHINGTON, D.C. 2056ti IfC 21o1 APPROVED BY OMS 3150 0060 EXPIRES 4 3043 REQUEST FOR ACCESS AUTHORIZATION

1. D A TE INSTRUCTIONS: Prepare in triplicate. Detailed instructions are on reverse.

2.TO:

3.FROM:

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Chief

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Personnel Security Branch Division of Security U.S. Nyelear Regulatory Commission

4. SIGNATURE Washington, DC 20555

5. REQUEST THE BELOW NAMED APPLICANT, A U.S. CITIZEN, SE PROCESSED FOR AN NRC ACCESS AUTHORIZATION AT THE FOLLOWING LEVEL:

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6. N AME OF APPLICANT (Last, first, Middle)

7. DATE OF 81RTH 8 REMARKS:

9.' NRC SPONSORING OFrICE OR DIVISION (See instructions)

10. CONTRACT NUMBER OR OTHER IDENTIFYING NUMBER

11. ENCLOSURES:

'Wh*100 NOTWRITEHN THIS SPACG MCfMW

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INSTRUCTIONS A.

PURFOSE OF FORM:

This form is to be used for requesting NRC access authorizations on personnel of N RC contractors, subcontractors, licensees, employees of other government agencies, or other liidividuals who are not applicants for employment with..NRC. _

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WHO PREPARES FORM:

The agency or firm employing the individual normally prepares this form (except in the case o'f a suticontiactor in which case

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the prim.e contractor would prepare this form). The N RC Sponsoring Office or Division may prepare this form if it feels it would be more ex'oedient.

S C.

APPROVALS REQUIRED:

Item 4 must be signed by the agency or firm security officer gor other authorized official). If this request is in connection with an N RC contract, or anticipated contract (e.g. basic ordering agreement), items 9 and 10 must be completed and the request must be approved in item 12.

D.

SUBMITTING REQUEST:

All requests may be submitted to the address in twm2; however,if approval in item 12 is required,it would avoid delay in pro-cessing if this reauest is submitted through the approving official. Security forms completed by the applicant are to be firmly attached to this form.

E.

PRIOR INVESTIGATIONS AND SECURITY CLEARANCES:

To assist in the processing of this request, please list in item 8:

1. Any prior investigations on the applic' ant. Give date, type (i.e. background investigt tion or national agency checks), and investigating agency; and,

2. Any current or prior security clearances (i.e. access authorizations) held by the applicant with NRC or any other agency. Give dates held, level (i.e.

Top Secret, Secret, Confidential, "Q", or "L"), and agency granting clearance, a

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