ML20059G857

Partially Deleted Ltr Forwarding NRC Form 148,for Signature

ML20059G857
Person / Time
Issue date:	10/26/1982
From:	Smidth P NRC OFFICE OF INSPECTION & ENFORCEMENT (IE REGION III)
To:	Saenger AFFILIATION NOT ASSIGNED
Shared Package
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References
FOIA-93-34 NUDOCS 9401260007
Download: ML20059G857 (3)

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UNITED STATES NUCLEAR REGULATORY COMMISSION

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GLE N E LLYN, IL L8Nol5 60137 October 26, 1982 Dear Dr. Saenger -

Please sign and return the original and 2 copies of the NRC Form 148 attached. An extra copy of the form is enclosed for your record.

Your prompt attention to this matter will be appreciated.

Sincerely, f

AI Pearl T. Smi th l

Phone: 312-932-2655 I

I (FTS 384-2655)

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DAVIS 93-34 PDR-

n UJ. NUCLE AR AEOULATORY COMMiuow UNIT IOC ow an/y/

NRC e onu 146 (a 7sl NRCM.,,,

j VOUCHER FOR PROFESSIONAL SERVICES INSTRUCTIONS This twm shaft be completed by o!! NRC consjite n for claiming compensa tion for officist authorisedpersonal services.

A signed originnt and two copies should be subrnitted to the NRC office authorizing the service.

TO:

FROM.NAME OF CLAIMANT U.S. Nuclear Fle;platory Comminion Eugene L. Saenger, M.D ATTENTION: NRC OFFICE AltTHORIZING THis SERVICE STREET ADDRESS CiDCinnati General llOSpital i

234 Good: nan Street Division of Engineering and Technical Prog.

CtTY STATE ZIP CODE Region III Cincinnati Ohio 45267 799 Roosevelt Rd.

%C Y NUE R CITY STATE Z6P CODE Glen Ellyn IL 60137 DESCRIPTIO1MF CLAIM (Allblocks must be completed)

N UM BE R DATE CONT RACT:

AT (49-24)*1023 7/1/82-6/30/82 AMOUNT CLAIMED PERIOD lFAOM lTO DOLLARS CfNTS COVERED:

4 /7/82 6/11/82 footest NUMBER OF DAYS PER DAY SERVICES PE RFORMED:

g l NUMBER OF HOURSl PER HOUR (f,my, on re.o rm s y

206 88 21.25 9%

g RETIRED ANNUIT ANT :

vES O NO 3 TOTAL AWOUNT CLAlWED i

OFFICE OF THE CONTROLLER USE ONLY CERTIFICATION A hO UNT VE RIF IE D I CER Tif Y that the about account is just and COR RE ci true in a11 respects; that my statement of s*rvges SnGNATURE correctly sea forth the services on official business: that the payment therefore has not been received; and tha t no ccenpensa tion fx my AppnoyAL of the time shown above is payable frun or willbe claimed frcrn any other source of t%e I CER Tif Y that the above clsim is just; that fecterst Government or in cost reimbursable the above services were officially requested andperformed; and that the expenses ctsimed ere authorized ICteame r's s ornature!

LApprovine O ttner'u sqrna ture) tDate of Certfcorrent LO*rt Approv*di NRCFORMIdf MEPL. GE S F O.

. At c 8 WHICH IS OB5oLETE AND E Xi$T4NG STOCK EHOULD SE DESTROYE D.

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SERVICES PERFORMED t

RATE OF COMPE NSATION PLACE ISI OF WOR K PE RF ORME D PE R DAY PE R Houm s

21.25 cincinnati, Ohio TlME WOR K.E D OR IN AUTHORIZED STATUS linaces wheen enae.m. orp.mJ DATE FnoM To TOT AL Houns April 7, 1982 I' m 1:30pm p

j April 8, 1982 10am 10:30am April 16, 1982 3pm 4:30pm 1%

April 20,1982 2pm 3pm 1

April 22, 1982 Ilam 11:30am April 23, 1982 9am 10am 1

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April 27,1982 10am noon 2

May 13, 1982 2pm 2:30pm j

May 14, 1982 4:30pm 5:30pm 1

l June 11, 1982 12:30pm 1:30pm 1

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4 PRIVACY ACT STATEMENT Pursuant to 5 U.S c. 652etel (3). enacted into law by section 3 of the Priveey Act of 1974 IPublic Law 93479), the following statement is turnished to individuals who mapply informstion to the Nucteer Repstetory Commission on Form NRC-144. This informaten is maintained

&n a system of recorda dos.pneted as NRC-20 and described et 40 Fedoest Repster 45341 IOctober 1,1975).

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1. AUTHORITY 31 U.S.C. 21,22,24,49,54, and 66e. Eolicitation of the nocial security number es suthoritad under Exoeutive Order S397 detod Nprember 22,1D43.

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2. PRINCIPAL PURPOSE 15)

Informat.on entered on this form is used to secure perment for autherared claims for tempenesten.

3. ROUTINE USES Information on this form is used for tronomitui to the U.S.Treneury for payment. The informaten mey eles be desclosed to en oppropriate Federal, State, or local opney in the event to information indicetes a violaten er potentaal enoletion of low and in the sourse of an ashninistrative or judecial proceeding. In addition, this er.?nrmetien may be transferred to en appropriate Feoeret, State, and local opency to the entent relevent end necessary for en NRC decision er er, en anaro-W Ne=s:as:w to the extent relevant and necemory for that opency's decisian about you.

4. WHETHER DISCLOSURE IS MANDATORY OR VOLUNTARY AND EFFECT ON INDIVfDUAL OF NOTPROVIDING INF ORMAT ION The neplyins of this information is voluntery on your port. Failure to supply the intarmetien,however, oney result in the denial of your claim for compensation, Your social securfty number is used as en identifest end its use is necessary be seuse of the lary number of present end forener Federef employees with similar names ered berth estes.

5. SYSTEM MAMACERCS) AND ADDRESS Controller, Offace of :..e Cont ofler, Uf. Nucasar Repalstory Commission.

Washm;1on, D.1 20565

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