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MEMORANDUM FOR: Llewellyn J. Evans, Jr., Chief Fuel Facilities Safeguards Licensing Branch Division of Safeguards Office of Nuclear Material Safety and Safeguards Royal J. Voegeli, Attorney Operations and Administration Division Office of the Executive Legal Director FROM: Duane G. Kidd, Chief Security Policy Branch Division of Security Office of Administration
SUBJECT:
MATERIAL ACCESS AUTHORIZATION ACKNOWLEDGMENT FORM The existing " Security Acknowledgment" (NRC Form 176 - copy enclosed) .is currently completed by each applicant for an NRC security clearance or access authorization. This form is not particularly applicable to the access authorizations which will be granted to employees of licensees under10CFRPart11(MAAP).
A draft " Material Access Authorization Acknowledgment" which should be more meaningful under this program is also enclosed. Your review and comments on this draft form would be appreciated. Feel free to contact Richard Dopp (x74549) of my staff if you have any questions.
Quane G. Kidd, Chief Security Policy Branch Division of Security Office of Administration
Enclosures:
As stated 8601090385 851223 PDR PR 11 50FR39076 PDR
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NRC FO M 176 US. NUCLEAR REGULATORY CoMMISSloN WASHINGTON.D.C. 20555 0 80)
NRCM 2101 SECURITY ACKNOWLEDGMENT l , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , i n a n tic ip a tion o f my security clearance or access authorization by the United States Nuclear Regulatory Commission, make the following statement with the understanding and intent that my statement will be used by the N RC in carry-ing out its obligation to protect the security of Restricted Data and National Security Information.
- 1. I understand that it is the policy of the NRC to control the dissemination of Restricted Data and National Security Information in such a manner as to assure the common defense and security.
- 2. I understand that, in carrying out the aforesaid policy, the NRC has issued and will issue and revise, as circumstances require, certain instructions and regulations pertaining to the control and dissemi-nation of Restricted Data and National Security Information.
- 3. I shall not reveal to any person any Restricted Data or National Security information of which I gain knowledge as a result of my employment, assignment, or duties, except in accordance with official instructions and regulations of the NRC or except as may be hereaf ter authorized by officials em-powered to grant such authority.
- 4. I understand that the provisions of the Atomic Energy Act of 1954 prescribe the penalties for the dis-closure of Restricted Data to unauthorized persons, and the provisions of U. S. Code, Title 18,
" Crimes and Criminal Procedures," prescribe penalties for the disclosure to unauthorized persons of information respecting the national defense, and for loss, destruction or compromise of such infor-mation through gross negligence.
- 5. I understand that revealing or disclosing Restricted Data or National Security Information to any unauthorized person may constitute sufficient cause for termination of my association with the nuclear regulatory program.
- 6. I understand that the Nuclear Regulatory Commission desires to be informed when persons granted NRC security clearance propose to travel to communist controlled countries in order to inform the individual of the possible risks to personal safety in view of the classified information known to the individual. The NRC's security interest in such travel normally diminishes as the period of access to Restricted Data or National Security Information becomes more remote.
- 7. I understand that I am to notify the NRC Division of Security as soon as it is practicable of all arrests, charges (including charges that are dismissed), or detentions by Federal, State or other law enforce-ment authorities, for any violation of any Federal law, State law, county or municipal law, regulation or ordinance, other than traffic violations for which a fine of $50 or less was imposed, occurring dur-ing any period in which I may hold N RC clearance or which occurred subsequent to the completion of the Personnel Security Questior naire which I executed on .
(Insert date of Personnel Security ouestionnaire) oATE SIGNATURE PLACE AT WHICH SECURITY ACKNOWLEDGMENT IS SIGNEo NAME OF EMPLOYER G'*C*"**
NRC FORM 176 (880) SUPERSEDES PREVIOUS EolfloNS.