ML20077H463
| ML20077H463 | |
| Person / Time | |
|---|---|
| Issue date: | 07/31/1983 |
| From: | NRC OFFICE OF ADMINISTRATION (ADM) |
| To: | |
| References | |
| NUREG-BR-0062, NUREG-BR-0062-V01-N1, NUREG-BR-0062ER, NUREG-BR-62, NUREG-BR-62-V1-N1, NUREG-BR-62ER, NUDOCS 8308100498 | |
| Download: ML20077H463 (38) | |
Text
NUREG/BR-0062 UPDATE NUMBER: 1 Vol.1, No.1 Page 1 of 3 fa arcoy
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i United States
\\;3 Nuclear Regulatory Commission NRC Forms Facsimile Handbook PAGE ACTION CHANGE TO READ FORM NUMBER iii CHANGE
'E.1.
Replacement pages of new or revised forms will be provided semi-annually. A lag time of 30 days may occur due to unforeseeable processing problems causing new or revised forms to be included in the following semi-annual update.
1 ADD Building Alteration Inspection Report NRC Form 342 Certificate of Compliance Condi_tions Continued NRC Form 618A 2
CHANGE Classification Record NRC Form 790 DELETE Distribution Category A & B NRC Form 33 ADD Document Distribution and Control NRC Form 33 4
DELETE Letter Request and Authorization for Employee Training Services NRC Form 74 DELETE Letter to ACRS Transmitting Category A Documents NRC Form 19 DELETE Memo Transmitting Voucher for Services Rendered NRC Form 370 5
ADD Operator Examination Report NRC Form 157A DELETE Operator License NRC Form 174 6
ADD Quarterly Report Layout (IE)
ADD Senior Operator Examination Report NRC Form 157C l
CHANGE Senior Operator Upgrade Examination Report NRC Form 157B DELETE Senior Operator License NRC Form 78 O
Office of Administration hR PDR BR-OO62 R l
UPDATE NUMBER:
NUREG/BR-0062 Vol.1, No.1 Page 2 of 3 Ol PAGE ACTION CHANGE TO READ FORM NUMBER 9
CHANGE Assignment Management System _ Event or IRS, SER and SOER Screening Records NRC Form 423 SEE NRC FORM NUMBER FOR PAGE NUMBERS Remove line in upper right corner:
" Expires 2-31-83", instruction page and page 1 NRC Form 2
" Expires 4-30-83" NRC Form 4
" Expires 4-30-83" NRC Form 5
" Expires 11-30-84" NRC Form 7 Stock Number to NRC Form 46 NRC Form 46 ADD Forms Facsimile Data above Unit of Issue "1/83" NRC Form 89, FACE Construction of Form, Remove X MP/5 NRC Form 103A Stocking Point to Warehouse and Supply Rooms NRC Form 122 Remove line in upper right corner: " Expires 4-30-83" NRC Form 136 Stocking Point to Warehouse, add stock number:
W7540-00-NRC-0157A NRC Form 157A W7540-00-NRC-0157B NRC Form 157B W7540-00-NRC-0157C NRC Form 157C Stocking Point to Warehouse NRC Form 172 ADD Construction of form X Sheet, 823 x 14", blue NRC Form 1908 Remove edition date at bottom left corner of replica NRC Form 210 Remove line in upper right corner:
" Expires 4-30-83" NRC Form 237
" Expires 10-31-83" NRC Form 241 Stocking Point to Promulgating Office, remove stock number NRC Form 268 Remove line in upper right corner: " Expires 4-30-83" NRC Form 277 ADD Stocking Point, Promulgating Office NRC Form 293 Remove line in upper right corner: " Expires 9-30-83" NRC Form 313M ADD NRC FORM 316 to upper right corner of page NRC Form 316 Stocking Point to Warehouse and Supply Rooms NRC Form 321
UPDATE NUMBER:
NUREG/BR-0062 Vol.1, No.1 Page 3 of 3 f}
V PAGE ACTION CHANGE TO READ FORM NUMBER SEE NRC FORM NUMBER FOR PAGE NUMBERS ADD Stocking Point to Warehouse, add stock number W7540-00-NRC-NRC Form 327 0327X pts. 1 & 2 Stocking Point, Warehouse and Supply Rooms NRC Form 346 Stocking Point to Warehouse, add stock number:
W7540-00-NRC-0366X NRC Form 366 W7540-00-NRC-0396A NRC Form 396A W7540-00-NRC-0398X NRC Form 398 Page 4 to read NRC Form 44_3, Page 4 NRC Form 443 L-322 to MNBB 11104 NRC Form 704, Reverse, pt 4 Stock Number to 7540-00-NRC-0707X NRC Form 707 Remove line in upper right corner: " Expires 6-30-83" NRC Form 742C ACTION ACTION ACTION DESTROY PAGE ADD / REPLACE DESTROY PAGE ADD / REPLACE DESTROY PAGE ADD / REPLACE NRC FORM PAGE NRC FORM NRC' FORM PAGE NRC FORM NRC FORM PAGE NRC FORM 6
6 229 229 423 423 33 33 292 292 431 431 72 72 310 618 618 78 311 618A 91 91 329 709 709 111 331 721B 7218 173A 335 335 772A 772A 174 342 772B 772B 184 368 368 790 790 214A 368A 368A 217 374 374 SF-162
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DATE STANDARD ORDER FOR INTERAGENCY WORK ISSUED TO (Agencyl ISSUE D BY; (NRC Of f e,)
ACCOUNTING CET ATION APPROPRI AllON SYM80L B&R NUMBL R PERFORMING ORGANIZATION AND LOCATION FIN NUMSk R WOR K PE RIOD - THIS ORDE R fixed C ESTIM ATED C FIN TITLE FROM.
TO.
08 LIGATION AVAILABILITY PROVIOED BY:
S A. THIS ORDE R S TOTAL OF ORDER $ Pt ACED PRtOR TO THaS DATE WITH THE FERFORMING ORGANIZATION UNDER THE SAME ' APPROPRI ATION SYMBOL" AND THE FIRST FOUR DIGITS OF THE S
'E &R NUVBER ' CITED ABOVE C TOTAL ORDERS TO DATE (TOTAL A & Bf g
D AMOUNT INCLUDE D IN "C" APPLIC ABLE TO THE FIN NUMBE R" CITED IN THIS OR DE R.
S FINANCIAL FLEX 18tLtTV-O FUNDS WiLL NOT BE REPROGR AMMED BETWEEN FINS LINE D CONSTITUTES A LIMITATION ON OaLIGATIONS AUTHORIZE D.
O FUNOS MAY BE REPROGRAMMED NOT TO EXCEED 110%OF FIN LEVEL UP TO $50K. LINE C CONSTITUTES A LIMITATION ON OsLIGATIONS AUTHORIZED STANDARD TERMS AND CONDITIONS PROVIDED THE PERFORMING ORGANIZATION ARE CONSIDERED PART OF THIS ORDER UNLESS OTHERWISE NOTED. ALL ACCEPTING AGENCY CONTRACT PROVISIONS ARE ACCEPTED BY NRC.
ATTACHMENTS.
THE FOLLOWING ATTACHMENTS ARE HERE8Y SE CURITY.
- m. \\
MADE A PART OF THIS ORDE R O WORK ON THIS ORDER IS NOT CLASSIFIED.
O STATEMENT OF WORsC O WORK ON THl3 ORDER INVO~.VES CL ASSIFIED INFORMATION NRC FORM 187 IS ATT ACHE D.
C ADDITIONAL TERMS AND CONDITIONS g
O OTHER REMARKS: (Wort under thuterneencr ogreenent n eathoraaf punuant ro P L. 93 438 5 ISSUING AUTHORITY ACCEPTING ORGANIZATION StG N A T u mE SeGNAfung 16 T L E TI T L E NRC ronM 173A (5 41)
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LOST BADGE REPORT N
LOST S ADGE INFORM ATION (Pisees type or pnarf
" ^ " ' " ' " * " " "
TO:
FACluTY AND SYSTEMS SECURITY BRANCH DIVISION OF SECURITY wrm OFFICE OF ADMINISTRATION arenomesati pate or toss oats or aseomt Exetasaaren op toss I certdy the badge usued rne fur use was lost and the above informaten a true and correct to the best of my knowledge and behof. I understand the badge whch I have reported as lost e the property of the United States Government and anno understand its counterfeetsgl. altavatens, or mouse is a velaten of Sec. 499 and 701. Title 18 U.S. Code.
. of If and when I recover the badge. I agree to retum it, without fail to the offce of esue. I am aware of the fact that retenten may constrtute allegal ;
govemment property.
h secanatuas TO BE COMPLETED BY FACILITIES AND SYSTEMS SECURITY BRANCH RECORDS TO BE DOCUMENTED REPORT OF LOST SACGE RETURN OF LOST SADGE NRC FORM R SADGE REQUEST INSERT ACCOUNTABiUTY LOST SADGE REPORT NTIALS newAmas NPC poem 217 save FORMS MANAGEMENT DATA 7/83 PROM
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PRIVACY ACT STATEMENT Pursuant to 5 U S C. 552ateH31, eries.ted mto law by secten 3 of the Privacy Act of 1974 (Pubhc Law 93 $791 the fomowmg staternent is furrushed to wk dividuais who supph enformaten to the Nuclear Regulatory Commewon on NRC Form 217. The snformaten e mamta ned in a system of records deugnated as NRC-39 and described at 40 Federal Reg ster 44533 f $eptember 26,1975).
- 1. AUTHORITY Section ta5 of the / tomc Energy Act of 1954. as amended (42 U S.C. 21661.
- 2. PRINCIPAL PURPOSEISI Mformataan entered on the form e used to control the flow and memtaan the accountabety of xlentefcaron badges moved by the NRC.
- 3. ROUTINE USES The informaten may be decioned to an approprete Federal, State. or local agency a the event the informaten mdacates a violaten or potenties vio6aten of law and m the course of an admmetrative or ludces proceedeg in addeten, the wiformaten rnay be treWorred to an approprote Federa:. State, and local am to the entent relevant and necessary for en NRC deceen or to an appropnate Federal agsncy to the extent relevant acwt necessary for that agency's dece.on about you.
4 WHETHER DISCLOSURE IS MANDATORY OR VOLUNTARY AND EFFECT ON INDIVIDUAL OF NOT PROVIDING INFORMA-TION Deciosure e voeuntary. If the requested eformaten a not provided. however, an usentifcation badge or access to secunty areas may be derwed.
- 5. SYSTEM MANAGER (S) AND ADDRESS Director, Dans nn of Securg Omco of Admaustraten i
U S. Nuclear Regulatory Commeson Washington. D C. 20566 1
0
NRC FORMS FACSIMILE HAND?.OOK NRC FORM 229. FACE
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[N AND APPROVAL PP. LOR TO PAYMENT vovcuta seuMain oAfg The attached tsee item checked belOw) which was received by the Divi-e w
sion of Contracts on
. is forwarded comraAct muMean
' cominAcron for your review and recommendation for approval /suspen-a ir R NUMBER Fem huMete sion/ disallowance prior to payment, l Progress l
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PART 1-NRC Propet Officer will complete within the stated number of days for the following:
l NORMAL PROCESS.14 DAYS l l PROMPT PAYMENT ACT.7 DAYS l l DISCOUNT DAYS 9tPonflNG PtRiOo mesisame== aeasiens ves e as eineanter oweaswoogo Empseas as anseerssereneses e are #2seemcoupeee un ainesawalureeM v
OUESTION YES NO
- 1. Did the Protect Offcer vet the contractor or d d the contractor vises NRC dunne ttus reporting per odP 2 Was a report of the visit submitted to the contractmg office?
3 If the answer to guestion 1 es "no", has there been other contact with the Contractor durmg ti a penod7
- 4. Is the contractGe (Berformang satisf actordy and wethen the scope of the contractP 5 Has the contractor submitted all required reoorts in acceptable order and in a tweefv mannerP 6 is the contractor ussng personnel with the requwed skills for enasernum performance?
P 7 te the contractor dedicateg the effort set forth in.he contract a WtB the contractor meet the cornpletion date specstied in the Contract?
?
9 Are the uneapended funds suttacient lo cortpiete the services requesd in the contract P
10 Has the contractor been supplied aN government turnished property requwed m the contract tt were as problems that may adversesy a"ect performance and or cost brought to the attention of the contracteg offwer e a inneiy mannerP P
- 12. Mas the contractor met the dehvery schedule es set forth in the cytra(I 13 COMMENTS I have esammed the referenced voucher en relation to the contractor's progress and technical aspects of the stems clawned and recommend the fonoweg.
l *ayment en the amount of 8 l l Wethho6deg pavmerit pending cientication in the tonowing areas of concern J
SIGNATURE PROJECT OFFICER DATE SIGNATURE ut requwed by your dives on or other aumorved representatsve.)
PART II Centracting Officer well complete I have enammed the referenced voucher,consedered the recommendations of the reviewing Protect Officer. and request the following action be taken. IFor suspension and or desallowances. please attach Division of Contracts letter of emplanation to contractorJ l Payment in the amount of g
} RE ASONS FOR SU$ PENSION ' DISALLOWANCE l Suspens on m the amount of $
]Deanowance wi the amou t of S n
SIGN ATURE -CONTRACTING OFFICER OR DESIGNEE DATE I
PART HB NRC ControHer will complete Payment in the amount of $. _ _ __
has been made.
A deduction an the amount of $' _
f amount of $
has been made from the voucher and the temaining payment m the
_has been made SIGNATURE CONTROLLEN REPRESf NT ATivE DATE FORMS MANAGEMENT DATA 7/83 PROM ATING U
CONSTRUCTION OF FORM PRESCRIBING DIRECTIVE STOCK NUMBER U
SHEET CARD ADM:DC 7540-00-NRC-0292 X HD 6-83
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SaGNAfuRE OF OFF5CIAL AUTHOR 11ED TO 8SSUE CERf15sCatE DATE I
YtTLE NOTE THIS CERTIFICATE, WHEN FILED. BECOMES A PART OF THE COMPETITOR'S QUAUFICATION STATEMENT.
FORMS MANAGEMENT DATA 77g3 PROM GATINC UN E
CONSTRUCTION OF FORM PRESCRIBING DIRECTIVE STOCK NUM8ER g
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- 3. IDENTIFICATION OF FILING UNIT (include type of record, function performed, and other descriptive facts)
- 4. VOLUME (cu. ft.)
- 5. DATES (inclusive)
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Gov t faciot.es iSee G 2 on eeverse t 12 HOME ADDRESS 13 NRC - PAID TRAINrNG RE C E lvt D DURINO PAst TWO VE ARS TELEPHONE NO B. PROPOSED TF:AINING DAT A 1 NAME OF F ACILITY l TELE PHONE NO 2 LOCAT ON OF TRAINING f se seare as fac,hty me a Don
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a STREET ADDRESS a STREET ADDRESS n CITY lST ATE l zip CODE E DUCA TIONAL CODE b CITY pTATE lliP CODE la GOVERNMENT TO BE mawu.e tvM sousei t $/d.
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I D NON-GOVERNMENT y Mets a DUTV h.asON.OUTv c TOT AL a SY88rY b COMPLETE S ACTUAL TPAtNING H TRAINAG DATES DAY HOURSid dyrs eecas VE AR l MO111 111 11i i i 1 (6 dstrs eacN YEAR MO DAY All11 l
6 TsTLE. COURSE NUMBE R of appoceDrei BRiEF DESCRIPT60N AND SOURCE OF INFORMATiON h net.srorsqr aqpone'#nr mat on e1e**ere 8 o
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egg CONTINUED SERV 6CE AGRE EMENT REQUtRED FOR ALL NON-GOVERNME NT TRAINtNG E NCEE DING 80 HOURS See Section F on the reverlie SPE-CIAL INSTRUCTIONS FOR TRAeNtNG REOutRING A REQUEST AND AUTHORIZATION FOR OFFICIAL TRAVEL. NRC FORM 2T9 inis trearg must re
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f C. COST AND FUNDS OBLIGATION D. SIGN ATURE S OF R E QU E ST E R.
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4 PHOPOSE D TRAtNING IS AUTHORIZED ITremmg Otr csat IDATE 121 TRAVE L ADM MDTS. f 30 0 492-78239 I
(3) OTHER fSpece99 SUSTOTAL S THE RE ARE SUFFIC'ENT FUNDS TO COVE R THE DIRECT lDATE ApM 6 scar seer,S ST ATED IN C 1 a f Apprognate Othciet TRAINtNG COST TOTAL 9
1 TUITir)N INCLUDED MEALS AND LODGING l DATE 6 THERE ARE SUFFICIENT FUNDS TOCOVERINDIRECT lDATE s
YES tr yet Appropriare MDTS Otr c.ars Sqnefore COSTS STATED IN C 1 tx 1 E TRAVEL, ETC t Appropreare NO off< sag 2 DOCUMENT NO iMDIS use onte BILLING ADDRESS U S. NUCLE AR REGULATORY COMMIS$10N E. FUNDING SYMBOLS OFFICE OF RESOURCE MANAGEMENT i APPHOPR ATION 2 B&R NUMBER 1 AGENCY STAf TON NO DIVISION OF ACCOUNTING AND FINANCE WASHINGTON, DC 20555 41 2 T-202 31 404)001 FORMS MANAGEMENT DATA U83 PROMULGATING U R OF EDmON CONSTRUCTION OF FORM PRESCRIBING DIRECTIVE STOCK NUMBER OF FICE ISSUE DATE f.
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NRC FORMS FACSIMILE HANDBOOK NRC FORM 368, PART 1. REVERSE F CONIiNUE D SE RViCE AGRE f VE NT NOTE. Thas agteement must be sveo by tee nom. nee tof an non government teamme that eaceeas 90 hours0.00104 days <br />0.025 hours <br />1.488095e-4 weeks <br />3.4245e-5 months <br /> and'or Nth Ine Gower nment approves pay-ment of trammg costs bef ore suc h tea *ng t;egma Ncthmg contamed m Ser tion F beroe sbad be t oc strued as i meting the authority of an ageno to esive. m ehose or en pa8't. art othgabon o# e I employee 10 pay empen%es mou"ed by the G0vernmerit m connes, t.on with the tramerig l
St CTION F E YPLOVE E $ AGRE E ME NT TO CONTINvE aN SE RVICE i
t AG AE E that ucen compietion ot the Gove'oment spensored traming descrited m tNs request d i recewe satary covening the teammg peraort l edi serve I
en the agent y three times the leng'h of the tramong pened H I ret e've no saiary duhrig t*, traimng pered, I agree toserve the agen( y tot a period equai to itie teng'h Of teai8img but sa t'o Case leas than one month IIbe 6ength of parl tire'e tea'ritrig talhe riurnDer of hou's sperit an Ciass or eeth 'he +Dattut icer I he tengeh of twil time h a turig is taght hours ol es(N day Of frairiang up lo a man muen ot 40 hours4.62963e-4 days <br />0.0111 hours <br />6.613757e-5 weeks <br />1.522e-5 months <br /> a ecesL I NOT E f or the purpose ot th4 agreement the tee m
' agency" refers 10 the emptPyeg organtiation tsuch as an E sec ubve Department or moependent estat+shment' not to a segment vi such an Organtistaofi 2 ft ' yoeuntardy leave the GQWy belore (ompleting the peruf o'servn e agreed to 4 Hem 1 at>ove i AGHf E to reer.butse the SQency *or the tuhon arsd re<ated teet travel and other soevai empenses +E SCE UDiNG SAL ARV) pand m conactfron erth my frammg These amounts are refiected in item C1 3 i FURTHE R AGRE E that d i vuunta iy leave the agem y tc enter the seru e of another F e.1e'ai age % y or Othee orgamrabon eri any branch of the Government befofe tomp6ebng the pered of servat e 4g ged f J e tem i above l e W gwe my orgamraMn etstten nette pl a16 east feri Workmg days dur-mg abic h bene a deterreimatori coricorsung 'petssesment ad' be made et t tad to give te,s advam e notit e i AGRE E to pay the amount of add tion espefise tS U S C 410+ adi mc utred t'y the Goverament m tNs t'a mng 4
I understand that any amounel eN h may ff due tO the aQenf y ai a cesuit of anyla dure on my part lo meet the terms of fNs agree tent may be withheld from any mor' es veed me tiv the Guvernment or may be necevered tiy sai. h cdhe, me' hods as are at$ roved t,y lee
$ t F URTHE R AG AE E to obtam epveva> bem my orsamsatori tra mrig of'n er arid that peeson eestonscie. for author.s.nq non.aovernme'it framir+g i
requests of any proposed (hange e my appeeve=d tra.rsmg per.sgram.sweivmg course and s= bedWe changes. e'thdramais or encompiet>Ons and
.nr reased C osts 6 4 at trio ** edge rN I tNs agreerr*ent deet not m any any (( m met the Gi.wern ment to c oobnue my empseyment f understand that d'hese is a transtet of rny service obhgabons tc ano'her F coera ageN y ne other orgamtaton m any beam M or the G weenment tne agecements m items t ? and 3 of this ss% bon edl temam m e e t unt4 I have C.omt. e-f ed my (@l ga'ed seren e wetri that othee age %, or orQan lat'on n
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.e, gavpg, g, p,ppgggy Traming is essent.a' to tae entcr(ement as t.v bes f rammg I"at emprvee car' take at h I e or no c ost to NHL otrer t*an baisy enoenses Tra.nmq that 4 Dart of a formal appenbr e tva mr.g prog'am m a sa-"ed trsde f raming tha.s reiatve'y short. Nghty spec ahrerivery oosery w ref ered arid of amme& ate apphrabon r
Trammg that 4 an meegra! part of a formai enqry neve. deveanoment psogram n
H F RAUDUL E NT CL A'US Doubie pay *esst o E de abonsi Aaceam es NormaHy 39 U $ C 1751 peo tuts edut driones anatames lay the Veterans A.3mmestam' ion IV A) to a veteran r
r who 2s attendmg a t ou se of educ.a' ion or tra+nmg pa.o f or under the Government E mp6oyees Teawng Act iGii As r
F raud The tollO*mg appMalde F ede'ai S14tutes pec+de r rimmes sam t.ons hv wrMW fraud Pl u S C 35021F ra adserst res e.pt of tundsteom v At IS U S C i
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Prepos e ' ens f,rm 'or aH te air my rebeS!s tf the r, Quester 4 hars$a apped or d.satned and m need 9 M+r at arrangesbents+ Bradhng tapeng anterpreters.
fa. ditv aa.ess b+ty etc) dem oL e the spec ta' arrangements on ni separare bheet and attarh oo the TRAIN;NG F ACILITY copy NOTE The requester is s'er s-Qna u e on TPe d*'st rept ve sheet mdata'e) agreement te eiease it to i ainmQ lacrbtreb not reavited to turmsh ins en'armatif ' M'Ini r
tompicte a th veQw ed o bre approva% through the othre frammg coordmatos to Mar' age-1 Reta.n the TRAsNE i PE NDtNG copv and forward trie set r
r ment Deveaopment and f rammg Sla"iMD?Si 0"ce of Admm+ strewn i ADM*
3 The MDTS *>llim in tee request and asvun a f rammg Request Number Attee the request s eev*emed and aposeved by the T'anageme"n.c M MDTS ae Authorizat onfor Trammg ietter s sent tothe Tra n ng Fac hty a r ryv o' the ammg O e
4 NRC F orm M is se nt ta tP* Of f.ce of Resou ca M t, f rammg Coordmatof and to the emp6cyee r
FR+VaCY ACT.S? ATF ME NT Pu suant to U S C St2aiew b enas ted mto bae by Sett on 3 of the Pr'vacy Art of 1974 iPubhc Lae 9 3 5 7% the toiloemg statement as turmshed to r
0smat.on to the Nuocar Argu a'oey Coremission on NRC F orm 368 Th.s mtormahon 4 mamtamed m a system cil records erid v+duMs Who suDpN mf r
des %nated as NRC 11 and NRC 19 and descr6 bed at 40 F ederal Hegister 4531/ and 453.11 rew.e n eN iOctorier 1 1975:
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AUTHORsTY 5 U S C 410 3 and E met ut we, Order 1 ? 34ft dated Aved70 1967 2 PRrNCWa t PURPOSE S inf ormahon entered on *rustorm eetales to t ai nommat.on tor reauested'rammu 6tn doc ument f or agenc y approval ot tramir4 n a non government f ar ehty tet bellmo document.
4cl docu, ment authort<5Q t'a omQ idi emplSymant agreement 80 be used when f*astimg es given tn reg s.atroet er cepeam e form for bam.rio c,u,ses 3 ROUTINE USES informa' on on ins form may tw rt srlosed to the Or*>re of Personnel Managemeht other Federal. State and local agencies and educational snst.tutens f ar use m ff ammQ programs reinted to NRC ef"Dibyeei 4 DE THE R DISCL OSURE *S MAND ATORY OR VOLUNT ARY AND EF F E C T ON tNDMDUAL OF NOT PROviDING INF ORM ATION Disclosureisvoturv tary H f he reques'ed mtormaton ts not prov'ded. you mig *o net rerew f u t rons.deraten for acceptave to a trammg cou se.'pergram in atuc h ttus mtor r
r matmost 4 rseeded 5 Sy%f t M M ANAGE A A ND #DDRE SS D' rector Maragement Devetopmeat acid fra,mg Sta" 0%e of Admmisiratiott U S Nudear Hegu6ery Com-m45,on, Wasemgton. D C 20S* 5 NRC F t
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U S. NUCLEAd REGULATURV COMMISSION NkuutM NvMBER NRC
- Osw 368A 2 sm. N acu eino EVALUATION OF TRAINING
.. BATE RREavEo aY M5tS PROOF OF COURSE COMPLETION MUST ACCOMPANY CV ALUATION ON ALL REIM8uRSEMENT REOUESTS.
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A. EMPLOYMENT INFORMATION
- 1. EMPLOVEE S NAME
- 2. 3OOAL SEQJRITY PC.
3 BaRTH DATE 4 edAIL STOP DOLE a MO. b. YR (AST lFIRST l
j8. GRADE / STEP li9. OFFICE PHONE NO. (/ pgers)
IONICE.DtVISION BR ANCa*
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NRC MANUAL APPENDIX 4150. P ART all G2s. REQUIRES THAT ALL TR AINiNG PAID FOR BY THE GOVERNMENT BE EVALUATED.
UPON COMPLETION OF THE TR AINING IDENTIFIED BELOW. PLE ASE COMPLETE ITEMS 1 THROUGH 16 OELOW AND ON THE REVERSE AND SU8 mat IT TO YOUR SUPERV.SOR FOR StGNATURE HE/SHE SHUULD SEND THE COMPLETED EV ALUATION FORM TO YOUR OFFICE TR AINING COORDIN ATOR WHO WILL F ORW ARD IT TO THE M ANAGEMENT DEVELOPMENT AND TRAINING STAFF (MDTSL MN88 3201.
B. PROPOSED TR AINING DATA 1 NAME OF F ACILtTY l TELEPHONE NO
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M RECOGNITION OF THE COMPLETION OF THl3 TR AINING WILL NOT BE ENTERED IN YOUR OFFICIAL PERSONNEL FOLDER UNTIL THIS EV ALUATION FORY HAS BEEN COMPLETED AND RETURNED TO UDTS THE EV ALUATION SHOULD BE SUBMITTto AS SOON AS POSSi8tE. BUT NOT LATER THAN TWO WEEKS AFTER COMPLETION OF TFiAINING SO THAT PAYMENT OF TR AINING EXPENSES M AY BE APPROVED.
C. EVALUATION OF TR AINING g
EVALUATION F ACTORS A
B C
1.
STATED OBJECTIVE ACCOMPLISHED YES PARTIALLY NO 2 COVERAGE OF SUBJECT MATT ER EXCELLENT SUF FICIENT POOR 3 ORGANIZATION OF SUBJECT M ATTER WE LL ORGANIZE D ADEQUATE POORLY ORGANI2ED 4 SUIT ABILITY OF INSTRUCTION AL M ATERI ALS EXCELLENT ADEQUATE POOR S LEVEL OF OtFFICULTY TOO A DVANCED APPROPRIATE TOO ELEMENTARY 6 LENGTH OF COURSE TOO LONG APPROPRIATE TOO SHORT 7.
AMOUNT OF OUT$rDE OR EVENING WORK TOO MUCH APPROPRIATE INSUFFICIENT 8 E FF ECTIVENESS OF INSTRUCTOR $
EXCELLENT GOOD POOR 9 APPLICABILITY OF SU8 JECT MATTER TO THE JOS SIGNIFICANT ADEOUATE INSIGNIFICANT 10 F ACILITIES EXCELLENT GOOO POOR 11 RECOMMENDATION TO COLLE AGUES HIGHLY RECOWENDED RECOMMENDED NOT RECOMMENDED 12 MEET CAREER DEVELOPMENT PLAN YES t
NO NOT APPLICABLE 13 R ATE AT WHICH COURSE PROGRESSED l
TOO FAST
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YOO SLOWLY JUSTRIGHT 14e SPECIFY THE AREAS YOU FEEL REQUIRE MORE EMPHASIS CONTINUED ON REVEPSE i
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.*mation entered on mis form e used to obten itse employee e evee at.on snout a Government nwGovernment trainmg w
Course of program 2 ROUTINE un s -inior n o s to,m me,.e d-=sedicit.e O.,.ce ot P-uanag.m.,,t otner re.a,N. sia.e endiocN agenc..s a,,d.ds,ca institutions for use in trenes prog,ams relawd to NRC employees 1
4 wHETHE R DISCLOSURE is esAND ATORY OR VOLUNT ARY AND EFFTCT ON INDIVIOUAL OF NOT P23W10tNG
- FORMATION - Disclosure e voeuntary I
1 5 $YSTEM MANAGER (5) AND ADDRESS. Drrector j
Management Developawet and Trainsng Slatt Onice of Adm.nististoon U $ Nucmar Regulatory Comm.ssion Weenegton. D C 20555 NRC FORM 3SAA l
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'"C* E ' 831 U.S. NUCLEAR REGULATORY COMMISSION g
i MATERIALS LICENSE Pursuant to the Atomic Energy Act of 1954.as amended, the Energy Reorganization Act of 1974 (Pubhc Law 93 438), and Title 10.
Code of Federal Regulations. Chapter I. Pans 30,31,32,33,34,35,40 and 70, and in rehance on statements and representations,
heretofore made by the hcensee, a license is hereby issued authonzmg the beensee to recetse. acquire, possess, and transfer byproduct, y
source, and special nugtear matenal designated below; to use such matenal for the purpose (s) and at the place (s) designated below,to I
This a dehver or transfer such matenal to persons authonied to recene it m accordance with the regulatmns of the appheable Part(s)
I bcense shall be deemed to contam the conditions specified m Section 183 of the Atomie Energy Act of 1954, as amended, and is subject to all appixable rules. regulations and orders of the Nuclear Regulatory Commission now or hereafte conditions spectfied below, I
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mEromT NvwsER tmANstATED TsT LE Docv ME N T D A T E O A.u,N AL LANOV AGE COUN T A,
TO THE REMAINDER OF THIS FORM MUST BE COMPLETED AND REtuRNEO TO:
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'T W 501. NO LATER THAN CLOSE OF BUSINESS (If this form is not received by the date above. TfDC w,Ilassume that the translation is acceptable. The translation willbe announced in the Weekly information Report. and made available in th.e NRC Library.)
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NRC FORM 790, REVERSE, PART 3 INSTRUCTIONS FOR COMPLETING NRC FORM 790 CLASSIFICATION RECORD Please note that NRC Form 790 must be completed by the Authorued Classifer for each classification or declassificaten review which O
resutts m an original or derivative classificaten. declassification. or classification level upgrade or downgrade. The Authorged Classifer must submit two copies of the completad and signed form to the Information Security Branch. Division of Security on the day the g(j classification or declassification review is completed.
COMPLETION OF FORM ltem 1 - To be completed by the Division of Security.
Item 2 -
Unclassified Doc.. ment Title. Begin title m space 7. Leave a space between words. Abbreviations are acceptable.
Item 3 - Insert date document was originated.
Item 4 -
Insert office symbol m spaces a3 51, current calendar year in spaces 52-53, and (document number in spaces 54-57 for Top Secret or Secret documents only.)
Items 514 Self Explanatory.
Items 15-Use the number assigned to you by the Divison of Security. Use right hand spaces if number has fewer than 4 digits.
FORMS MANAGEMENT DATA 743 PROM GATING UN T F EDIT N CONSTRUCTION OF FORM PRESCRIBING DIRECTIVE STOCK NUMBER
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NSN 7540-00-148 0169 Prescribed by Litrary of Conyens interlitrary Loan Code INTERLIBRARY LO AN REQUEST Dem of Not noemd Requumr's Remen for OLOAN or OPHOTOCOPY request:
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