ML20137T894

Request for OMB Review & Supporting Statement Re NRC Form 136, Security Termination Statement. Estimated Respondent Burden Is 40 H

ML20137T894
Person / Time
Issue date:	02/06/1986
From:	Norry P NRC OFFICE OF ADMINISTRATION (ADM)
To:
References
OMB-3150-0049, OMB-3150-49, NUDOCS 8602190005
Download: ML20137T894 (9)

Text

-

fD/t

., m . . . . . . . . .

7-..

st.,,mrmrm 8 3 / e '

e.n- . w, Request for 0MB Review - o #

important Read in5! ructions before crsmpletirig forni Do not use trm same SF 83 Send three copa s of the form, the ruterial to be reviewed, and for to request botn an Executivi: Order 12291 rmen and appimal under pape rwork- threo r.opies et the supportir,g stateme::t, to~

- the PJperwork Reduction Act Answer all quest:ons in Part 1. If this request is for rev.ew under E.O. Of fice of Informat.ori and Regulatory Af f airs 12291, compfete Part 11 and sign the segulator r certitication 11 this Of fice of Management and Buttget request is for approval under the Paperwork Redur.t on Act and 5 CFR Attention. Dochet labrary, Room 32ol 1320, skrp Part 11, complete Part til and s:gn t*.e paperwor k ce,tificat.on, Washington, DC 20503 PARTl.-Complete This Part for A!! Requests.

I i>epartmert/ agency and Bureau /ott.ce orevim. rego. st 2. 4,vncy cou U.S. Nuclear Regulatory Comission 3 1 5 0

3. f. lame of pe' son who can best answer gaest cns re,; arc.ng trut request Teiep5nne number Richard A. Dopp

4. Title of inform. hon collection er ru:erria= >r'g (301_ )492-41_24 NRC Form 136, Security Termination Statement

5. Legal authority f or information codection or rute (cca Un,rea St. *es Code, PuLhc la*. or becurac Order) usc , Executive Order 12356 __

- 6. Affected publ.c (checli all that apply) s O rederaiagene,es or empiores 1 O indi.ido :s or housenoids 3 0 raims e O Non prof.t irst.tutions 2 state or locas governments 4 [X Susinessen or other for-profit 7 0 smaii businesses or organeet.ons PART ll.-Complete This Part Only if the Request is for OMB Review Under Executive Order 12291

7. Regulation Identifier Number (RtN)

- - _ _ _ _ _ _ . or, None assigned O

8. Type of submissnon (check one m each catec5yi Type of review requested Ccssification Stage of development 1 O standard 1 O ua,or 1 O proposed er cratt 2 O Pendir,g 2 O Nonmajor 2 C Finat or intenm final. with pnor propou; 3 E Emergency 3 O Finat or intenm foal without pnor proposal 4 statutory or iud. cia! deachne

9. CFR secten affected CFR

10. Dces this regulation contain reportirg or ru orckeeping reau.rements that require OMB approval under the Paperwork Reduct'on Act and 5 CFR 1320? - O yes O No 11.11 a maior rute,is there a regulatcry repact awysutt ict co' 1 O us 2 O no It"Nn." did OMB waive the ana>ysis? 3 0 ws 4 0 No Cxrtification for Regulatory Submissions in submittmg this request for OMB reve *.tne autunzed m:watu ry contact and tr e precam off.ciat ce ti ty that the reauirr meets c' E O 122t41 amt in, arpi'ca04 pohty directives have been compt:ed w ti

~-

Signature of program official g, 8602190005 860206 synature of autt anied reguiator, costatt-- PDR DRG E , . . _ _ _

Oate i

I

12. to B use only)

Previo.n ed t ons otaoiete g3 g standard 7orm 83 the- 's e n NSN 7540 00 634 4034 bescr rwa t,, OM8 S Cm 1320 and E O 122H

PART lit./--Completa This Part Cnly if the Request is for Apprsvil of e C:ll:ction tf Informrti:n Und;r tha PJperwork Reducti:n Act and 5 CFR 1320.

luostroct--Desenbe needs. uses and af'ected oubhe 'n 50 *c'd5 *de55 " Security classified records, access authorization tennination" The NRC Form 136 affects the employees of licensees and contractors who have been granted an NRC access authorization. When the access authorization is no longer needed, the execution of the form apprises the respondent of their continuing security responsibilities and is used to initiate termination of the access authorization.

14. Type of information collection (check only one)

Information collect'?ns not contained in rules 10 Regular submission 2 O Emergency subm.ssion(cert t,catonattached)

Information collectrons contained in rules 3 O Existir g regulation (no change proposed) 6 Fmal or intenm final witnout prior NPRM 7. Enter date of espected or actual Federal 4 O Notte of progosed rutemaking(NPRM) A O Regular submisvon Register pubiecation at this stage of rulemakmg 5 0 rmai. Neau was previousiv pubusned e O Eme gency sutun.ssion(cert,r.caronattacned> (moata. dar. rear >

15. Type of review requested (check only one) 10 Newcollection 4 Remstatement of a previously approved collection for which approvat 2 O Revision of a currently approved collection D*'Pd 3 d Extension of ti.e empiration date of a currently approved collection 5 O Existing conection m use without an oM8 control number without any change in the substance or m the method of coHection

16. Ag:ncy report form number (s)(mctude standard / opt,onal form number (s)) 22. Purpose of enformatnon collection (check as manyas apply) i O Apphcation for benefits NRC 136 2 C Program evaluation

17. Annusi reporting or disclosure burden 3 0 cenerai purpose statistics 40 1 Number of respondents . 4 X) Regulatory or comphance 2 Numt'er of responses per responcent. 5 C Proram planning or management 3 Total annual responses (hne 1 times lene 2; 400 6 0 nesearen 4 Hours per response 1 7 O Au+t 5 Total hours (hne 3 times hn,4) 40

18. Annual recordkeep.ng burden 23. Frequency of recordseepmg or reporting (checir allthat apply) 1 Number cf recordkeepers 1 O Recordaeepmg 2 Annual hours per recordkeeper. Reporting 3 Total recordkeeping hours (hne 1 times 1,ne 2) 210 onoccasion 4 Recordkeepmg retention pero 1 years 3 g w,,gi,

19. Tctal annual burden 4 O Monthly 1 Rtquested (kne 17 5 plus hoe 18-3) .

40 5 0 Quarter'y 2 in current oMB enventory 40 6 0 semeannuany 0 7 O AnnuaHy 3 Difference (hne 1 less one 2)

Espl.tnation of difference 8 O B.enn.aisy 4 Program charsge 9 0 otner(descr,be>:

5 Adjustrnent .

20. Current (mnt recent) oM B contros number or comment number 24. Respondents' ot+ gat *on to comply (check the strongest obhgat on thatapphes) 3150-0049 13 Voluntary

21. Requested expiratiun date 2 O Pequired to obtam or retam a benefit 3/31/89 3 g y,naa n,yr

25. Ara the respondents pnmanff ecucationai agencies or inst:tutions or is the primary purpose of the collection related to Federal education programs > 0 ves El No

26. Does the agency use samphrg to select respondents or does the agency recommend or prescribe the use of sampling or statistical analysis

. O yes <.] y No by respondents?

27. Regulatory authority for the information col;ection 10 crR_25  ; or rR , or, othe,(sp,c,rf;.

Paperwtrk Certification in submittmg this request for oM'3 cproval the agency head, the senior off>ciat or an nutnorized representative. tertif'es that the requirements of 5 CFR 1320. the Pnvacy Act, stateshcal standards or nrectives, and any other appleatde informahen poi,4 rferMtives have been comphed with.

signature cf program offic.at Date NR r'ature nt :4gere y nead. the ww utficial nr an authonzed represer tativer D.ste Patricia G. Norry, Director# #g M, #,

)

~

Office of Administration

'9/ './ 'A G10 s VM40 - V,1- 71r

OMB SUPPORTING STATEMENT FOR NRC FORM 136 SECURITY TERMINATION STATEMENT Description of the Information Collection The reporting requirements associated with the NRC Form 136, " Security Termin-ation Statement," affects the employees of approximately 22 licensees and 35 contractors who have been granted an NRC access acthorization (security clear-ance). When the NRC access authorization is no longer needed, the employee acknowledges and accepts his/her continuing security responsibilities as stated on the NRC Form 136 by signing the form. Only a minimum amount of other perti-nent information (e.g., contract number, if applicable; date of termination),

none of which is personal in nature, is requested by the form. The form is countersigned by a representative of the licensee or contractor who administered the completion of the form by the employee.

There is no recordkeeping requirement for the licensee or contractor since the completed NRC Form 136 is to be forwarded to NRC Headquarters, Division of Security, for retention in the individual's Personnel Security File (PSF).

The established retention period of the PSF is: destruction upon notification of death or 5 years after termination of the last access authorization held.

Although maintained in the PSF, the completed NRC Form 136 would not fall under the exemptions of the Privacy Act of 1974 and, upon request, would be made available for public inspection in accordance with 10 CFR Part 9.

The use of this form affords some assurance that classified information and knowledge gained by the respondent will be properly protected and, therefore, benefits the NRC security program and public at large.

OMB SUPPORTING STATEMENT NRC FORM 136

A. JUSTIFICATION

1. Need for Collection of Information.

Section 5.3 of Executive Order 12356 requires agencies to

"... establish procedures to prevent unnecessary access to classified information, including procedures that...(ii) ensure that the number of persons granted access to classified information is limited to the minimum consistent with operational and security requirements and needs;..." NRC's response to this requirement is termination of the access authorization when the circumstances cited in Section 25.33 of 10 CFR Part 25 (applicable to licensees) or in NRC Management Directive 2101, Part VI, P. (applicable to contractors) exist. The NRC Form 136, " Security Termination Statement," is an integral part of these termination of access authorization procedures.

2. Agency Use of Information.

As stated in NRC Management Directive 2101, Part V, C.3., the completed NRC Form 136 is to be forwarded by the licensee / contractor to NRC Headquarters Division of Security (SEC) who uses the informa-tion in connection with the termination of the respondent's access authorization. In addition to providing assurance of NRC compliance with E.0. 12356, the NRC Form 136 is the vehicle used by SEC to apprisa the individual of his/her continuing responsibilities for protecting classified information that he/she had access to in the course of performing official duties. The individual's signature on this form indicates their acknowledgment / acceptance of these con-tinuing responsibilities. Failure to use the NRC Form 136 by the licensee / contractor may result in: (1) failure to terminate the NRC OMB SUPPORTING STATEMENT NRC FORM 136

_r

access authorization when circumstances dictate and, therefore con-tinued access to classified information; and (2) the individual not being apprised of, or officially acknowledging (by signature) his/her continuing responsibilities for protecting classified information.

3. Reduction of Burden Through Information Technology.

No reduction in the information collection burden can be realized through information technology with respect to the NRC Form 136.

The information contained /obtained on the form must be personally reviewed /provided by the individual affected.

4. Effort to Identify Duplication.

Section 25.33 of 10 CFR Part 25 requires that a representative of the licensee notify SEC in writing regarding the circumstances which necessitate termination of an individual's NRC access authorization.

Other than the fact that a particular access authorization is to be terminated, there is no duplication in the information collected by the NRC Form 136. This information collection does not preclude the need for other information provided by the NRC Form 136. No similar duplication exists in NRC Management Directive 2101, Part VI, applicable to contractors.

5. Effort to Use Similar Information.

Since the information collected by the NRC Form 136 is specifically and solely relat.?d to the termination of an individual's NRC access authorization, there is no similar information collection made by any other government agency which could be utilized. Other than as OMB SUPPORTING STATEMENT NRC FORM 136

o identified in item 4 above, there is no similar informatinn collec-tion made by NRC.

6. Effort to Reduce Small Business Burden.

None of the licensees affected by the use of the NRC Form 136 qualify i

as small business enterprises or entities. The burden associated with this form is so minimal that there would be no significant burden on a contractor, if they qualified as a small business enter-prise or entity.

i 7. Consequences of Less Frequent Collection.

The frequency of information collection is limited to circumstances when the respondent's NRC access authorization is to be terminated.

In most cases, a less frequent collection would mean eliminating the collection, as the access authorization of contractor / licensee employees are not frequently granted / terminated on a reoccurring basis. If the information is not collected, the assurance that nr.ly appropriately cleared individuals have access to classified informa-tion is reduced; and it is likely that individuals will be unaware of their continuing responsibility to protect classified information.

Thus, less frequent collection may endanger the U. S. common defense and national security.

8. Circumstances Which Justify Variation from OMB Guidelines.

There is no variation from 0MB Guidelines in the collection of information.

OMB SUPPORTING STATEMENT NRC FORM 136

)

9. Consultations Outside the Agency.

No consultations.

10. Confidentiality of Information.

The information collected is used to terminate a respondent's NRC access authorization. The completed NRC Form 136 contains no infor-mation of a confidential or personal nature and would not fall under the exemptions of the Privacy Act of 1974. Upon specific request, e

the form would be made available for public inspection in accordance with 10 CFR Part 9.

11. Justification for Sensitive Questions.

There is no sensitive information requested on the NRC Form 136.

12. Estimated Annualized Cost to the Federal Government.

The estimated annual cost to the Federal Government associated with the NRC Form 136 is $665.45. This cost was computed as follows:

NOTE: Annual form usage 400 (10% of the approximately 4,000 access authorizations held by licensees / contractors)

Costs:

Annual clerical effort = $533.40 (400 X 4.00 minutes = 26.67 hrs. X $20/hr.)

Annual professional effort = 79.80 (400 X .2 minutes = 1.33 hrs. X $60/hr.)

Annual record holding = 52.25 (i cu. ft. X $209/cu. ft.)

Total estimated annual cost = $665.45 i OMB SUPPORTING STATEMENT NRC FORM 136

In the current OMB clearance, the processing cost associated with the internal agency use of the form was inadvertently included, causing an inaccurately high cost to the Federal government. The above estimate is accurate.

13. Estimate of Burden.

4 An estimated six minutes is required to complete each NRC Form 136, resulting in a total annual burden on the public of 40 hours4.62963e-4 days <br />0.0111 hours <br />6.613757e-5 weeks <br />1.522e-5 months <br />. The estimated annual financial burden shared among the 57 licensees /

contractors is $2,400.00. This was computed as follows:

400 annual respondents (10% of the approximately 4,000 access author-izations held by licensees / contractors) X 6.0 minutes completion time each = 40.00 hours0 days <br />0 hours <br />0 weeks <br />0 months <br /> burden X $60.00 per hour = 8.?,400.00.

NOTE: There is no recordkeeping requirement / burden upon the contractors / licensees in that the completed NRC Form 136 is to be forwarded to NRC/HQS, Division of Security.

14. Reasons for Change in Burden.

There has been no change in the burden on the public associated with the completion of NRC Form 136.

15. Publication for Statistical Use.

There is no application of statistics on the information collection related to the Nh Form 136. There also is no publication of the j information.

OMB SUPPORTING STATEMENT NRC FORM 136

MC FonM 13 Ausew W oMe pas) 31'J00089 .

MCM 2101 Iap*** M1W f #f ems v & vt U. S, NUCLEAR REGULATORY COMMISSION WASHINGTON O. C, SECURITY TERMINATION STATEMENT N AME: (Print full name) PRESENT EMPLOYER:

CONTRACT NUMBER OR OTHER FACILITY OR INSTALLATION WHERE IDENTIFYING NUMBER: TERMINATEO:

DATE OF TERMINATION:

1 make the following statement in connection with the forthcoming termination of my access authorizatum granted by the Nuclear Regu;atory Commission:

1. I have destroyed in accordance with NRC security regulations or transferreJ to persons desagnated by the Nuclear Regulatory Commission all classified documents and material with which I was charged or which I had in my possession.

2. I shall not reveal to any person any National Security Information, Restricted Data, or other classified information of which I have gained knowledge except as authorized by law, regulations of the Nuclear Regulatory Commission, or in writing by officials of the Nuclear Regulatory Commission empowered to grant permission for such disclosure.

> 3. I am aware that the Atomic Energy Act of 1954 and U.S. Code, Title 18, Crimes and Crimiwi Procedures, presenbe penalties for unauthorized disclosure of Restricted Data, Formerly Restricted Data, and other information relatog to the national defense.

4. I am aware that 1 may be subject to criminal penalties if I have made any statement of material facts knowing that such statement is f also or if I willfully conceal any material fact (Title 18 U.S. Code, Section 1001).

5. I understand that the Nuclear Regulatory Commission desires to be informed when persons who have been granted NRC access authorization propose to travel to Communist <;ontrolled countries. This does not apply to individuals who obtain NRC access authorization and receive access to NRC classified information solely as employees of other Govemment agencies or their contractors.

(Signature of Person Conducting interview) (Signature of Person Whose Access Authorization is Being Terminated)

(Title of Position) (Date) m ^