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MEMORANDUM FOR: L. J. Evans, Jr., Chief P Fuel Facility Safeguards Licensing Branch Division of Safeguards, NMSS FROM: Duane G. Kidd, Chief Security Policy Branch Division of Security, ADM
SUBJECT:
MATERIAL ACCESS AUTHORIZATION ACKNOWLEDGMENT FORM Earlier this year we forwarded to you for comment, a draft form, subject as above.
Using your comments and in coordination with OELD we have developed the enclosed final draft. This draft will now be forwarded to the Document Management Branch for processing and printing. The form will ultimately become a part of the security packet completed by licensee employees affected by 10 CFR Part 11 and will replace the existing " Security Acknowledgment" form originally used in conjunction with this Part.
Your concurrence or additional comments on this form would be appreciated by June 11, 1982.
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Duane G. Kidd, Chief Security Policy Branch Division of Security, ADM
Enclosure:
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a y ,'O N NRCFORM g US. NUCLEAR REGULATORY COMMISSION (8401 WASHINGTON,D.C. 20555 NRCM 2101 MATERIAL ACCESS AUTHORIZATION ACKNOWLEDGMENT
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I, . , in anticipation of my special nuclear material access authorization
. by the United States Nuclear Regulatory Commission (NRC), make the following statement with the understanding 2
and intent that my statement will be used by the NRC in carrying out its obligation to assure the control and safeguarding of special nucle,ar material in accordance with the terms of the Atomic Energy Act of 1954, as amended.
- 1. I understand that it is the policy of the NRC to regulate access to, and provide for. control over, special nuclear. material.in.such
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a manner as to provide high assurance that activities. involving such material are not inimical to the coimion defense and security and do not constitute an unreasonable risk to the public health and safety.
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j 2. I understand that, in carrying out the aforesaid policy, the NRC has issuediand will issue and revise. .
i as circumstances require, certain instructions and regulations pertaining to access to and ccntrol of special nuclear material.
l 3. I. understand that any theft or other unlawful diversion of special nuclear material, or any attempt or conspiracy ttAreat,is a crimi-nal violation of the Atomic Energy Act of 1954, as amended, andis subject to. criminal penalties.
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- 4. ! understand that I am to notify the NRC Division of Security,as ests,
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soon charges (including charges that are dismissed) or detentions by Federal, flilitary, State or other law j
enforcement authorities, occurring during any period in which I may hold NRC special nuclear material V access authorization or which occurred subsequent to the completion of tlfe Personnel Security Questionnaire i which I executed on or about .
(Do net include traffic violations for which a fine 1 of $50 or less was imposed.)
Date Signature City and State Where Signed Name of Employer e
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