ML20207B361

Request for OMB Review & Supporting Statement Re NRC Form Form 354, Data Rept on Spouse. Estimated Respondent Burden Is 12 H

ML20207B361
Person / Time
Issue date:	05/18/1999
From:	Shelton B NRC OFFICE OF INFORMATION RESOURCES MANAGEMENT (IRM)
To:
Shared Package
ML20207B358	List: ML20207B353 ML20207B361
References
OMB-3150-0026, OMB-3150-26, NUDOCS 9905280217
Download: ML20207B361 (7)

Text

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3 PtX PAPERWORK DUCTION ACT SUBMISSION Pinse r:ad the instructions befora completing this form. For cdditionIl forms or assistance in completing this form, contact your agency's Paperwork Clearance Officer. Send two copies of this form, the collection instrument to be reviewed, the Supporting Statement, and any additional documentation to: Office of Information and Regulatory Affairs, Office of Management and Budget, Docket Library, Room 10102,72517th Street NW, Washington, DC 20503.

1. Agency / Subagency onginating request 2. OMB control number U.S. Nuclear Regulatory Commission g a. 3150-0026 b.None

3. Type of information collection (check one) 4. Type of review requested (check one)

a. New collection g a. Regular c. Delegated

b. Revision of a currently approved collection b. Emergency - Approval requested by (date):

g c. Extension of a currently approved collection 5. Will this information collection have a significant economic impact on a a.Yes

d. Reinstatement. without change, of a previously approved substa" .,al number of small entities?

collection for which approval has expired g b.No col o r h ch a rov h se Requested -

J a. Three years from approval date expirrtion date

f. Existing collection in use without an OMB control number

7. Title Data Report on Spouse

8. Agency form number (s) (if apphcable)

NRC Form 354

g. Keywords Federal employee, personnel security forms, access authorintion

10. Abstract Completion of the NRC Form 354 is a mandatory requirement for NRC employees, contractors, licensees, cpphcants, and others who marry after submission of the Personnel Security f orms, or after receiving an access euthorization or employment clearance, to permit the NRC to ensure there is no increased risk to the common defense and security.

11. Affacted pubhc quarn immary wth v eM an otneniIt,nr appry etn 'x*) -12. Obhgation to respond quem pnma y etn v ne en others Inst spory wtn 'x=>

T a Individuals or households d Farms a. Voluntary

b. Business or other for-profit e. Federal Government b. Required to ot,tain or retain benefits

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c. Not-for-profit institutions f. State. Local or Tnbal GovemmentT c. Mandatory'

13. Annual reporting and recordkeeping hour burden 14. Annual reporting and recordkeeping cost burden (m thousands atabnam

a. Numberof respondents 60 a. Total annualized capital /startup costs

b. Totalannualresponses 60 b. Total annual costs (O&M)

1. Percentage of these responses c. Total annualized cost requested collected electronically 0.0  % d. Current OMB inventory l

c. Total annual hours requested 12 e. Difference

d. Current OMB inventory 12 l

f. Explanation of difference

e. Difference 0 l 9 ""9'

f. Explanation of drfference

2. Adjustment

1. Program change

2. Adjustment ,

15. Purpose of information collection -16. Frequency of recordkeeping or reporting (check allrhar apply)

(Mark pnmary w4h *P* and a# others mat apply u@ T)

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a. Recordkeeping b. Third-party disclosure b

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a. Apphcation for benefits

e. Ptgram ptanmng or management 7 c. Reporting

b. Program evaluation f. Rewatch -7 1. On occasion

2. Weekly 3. Monthly I c. General purpose statistics T g. Psaulatory or corrofence 4 Ouarterly 5. Semi-annually 6. Annualty d Audit 7. Biennially 8. Other (describe) /_g

17. Stattstical metnode 18. Agency contact tverson who can best answer questions regardmg me , {

Does this information collection employ stattstical methods?

Name. Patricia A. Smith

]Yes g No Phone: 301-415-7739 OMB 83-1 r M,ereyes angwo uom wanns g j 10/95 9905280217 990518 PDR ORG EUSOMB h[1I i

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FINAL OMB SUPPORTING STATEMENT FOR NRC FORM 354

• DATA REPORT ON SPOUSE" 3150-0026 l Extension Request j Description of Information Collection. This reporting requirement affects approximately 60 individuals annually. The respondents are NRC employees, contractors, licensees, applicants ,

and others (e.g. intervenors) who marry after completing the Personnel Security Forms, or after i having been granted an NRC access authorization or employment clearance. l A. JUSTIFICATION

1. Need for and Practical Utility of the Collection of Information.

Section 145 of the Atomic Energy Act (AEA) of 1954, as amended, requires, before an individual can be granted access to Restricted Data (RD), an investigation and report on the individual's character, associations and loyalty and a determination that permitting such a person access to RD will not endanger the common defense and security.

The basic security standard of Executive Order 10450," Security Requirements for Government Employment," for employment, or retention of an individualin a sensitive position, is that such employment or retention is " clearly consistent with the interests of the national security." Executive Order 10865, " Safeguarding Classified Information Within Industry," likewise permits the " .. head of a department or his designee . " to grant access authorizations for industrial employees (NRC contractors) ". . on!y upon ,

finding that it is clearly consistent with the national interest to do so." Executive Order 12968, " Access to Classified Information," requires " Eligibility (for access to classified information) shall be granted " . consistent with the national security interests of the United States . "

10 CFR Part 10, Subpart B, " Criteria and Procedures for Determining Eligibility for Access to Restricted Data or National Security Information or an Employment Clearance," provides criteria to assist in making this determination. In order for NRC to implement this responsibility, it is essentinl, from a security standpoint, that NRC receive information concerning (1) non-U.S. citizen spouses of NRC applicants; (2) non-U.S.

spouses of NRC contractors, licensees, and others pending NRC access authorization processing; (3) spouses of NRC applicants, contractors, licensees or others who marry after applying for NRC access authorization; and (4) spouses of NRC contractors, licensees and others who marry after having been granted NRC access authorization.

The SF-86, revised in September 1995, which is used for initial investigations and reinvestigation, will collect the required information at these times. The NRC Form 354 will be submitted only as needed, e.g., at any other time marriage occurs to provide the detail needed for NRC purposes. Specifically, the NRC Form 354 provides the following information concerning the spouse's citizenship and parents: (1) whether the individual is a U.S. citizen, an alien or possesses dual citizenship. If a U.S. citizen, whether a) by birth, b) derivative (including date, certificate number, and Place) or c) by naturalization (including petition number, date, certificate number, and place). If alien, alien registration number, date of entry, port of entry and present citizenship; and (2) parents, to include name in full, date of birth, address, country of birth and present citizenship. This level of detail is necessary to (1) permit the NRC Division of Facilities and Security (DFS) to determine whether or not any information on the form has an impact on the respondent's initial or continued eligibility for access authorization or employment clearance; and (2) permit the Federal Bureau of Investigation (FBI) to complete a name check of FBI files.

Use of the NRC Form 354 will be limited to those individuals who marry subsequent to the completion of the SF-86 and who are not otherwise due for reinvestigation.

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2. Aaency Use of Information. Th3 information supplied idsntifies the respondent, the l marriage, and data on the spouse and spouse's parents. This information permits DFS to make initial security determinations as to whether or not any information on a specific individual's form has an impact on the respondent's initial or centinued eligibility for access authorization or employment clearance. Copies of the completed forms are sent to the FBI where a name check of FBI files is completed. In the case of non-U.S. citizen spouses and relatives, appropriate checks at other appropriate Government agencies are also completed. Upon receipt of the completed FBI and other agency checks, DFS makes second evaluations / determinations, based on developed information, as to  !

whether any action is required concerning the respondent's initial or continued eligibility )

for access authorization or an employment clearance. l

3. Reduction of Burden Throuah Information Technoloav. Because the information is required of individuals and not of corporations or businesses, and it requires an original i signature of the submitter, it is not possible to reduce the burden of 12 minutes per i respondent through information technology. No submittals are received electronically. l l

l 4. Effort to identifv Duplication and to use Similar information. Elements on the NRC Form 354 are duplicative of those on tho SF-86 (i.e., name of employee or applicant, other names used by employee or applicant, employment, date and place of marriage, present name of spouse, other names used by spouse, date and place of birth of spouse, present address of spouse). This duplication is necessary because the NRC Form 354 is normally completed independently of the SF-86 (i.e., when an individual rnarries subsequent to an initial investigation or five or ten year reinvestigation depending on the level of security clearance). No similar information, already available, exists. All such personal information required from an individual applying for or possessing an NRC access authorization, must be supplied by the individual. No alternative sources are available.

5. Effort to Reduce Small Business Burden. The licensees and others affected by this information collection are not small entities or businesses as those terms are used in the Regulatory Flexibility Act.

6. Consecuences to Federal Proaram or Policy Activities if the Collection is Not Conducted or is Conducted Less Freauentiv. There is no established reporting frequency or period for submittal of NRC Form 354. This form is submitted only when an applicant marries after completing Personnel Security Forms or marries after receiving an access authorization. If the information is not collected at all, DFS will be unaware of marriages which have an impact on the respondent's initial or continued eligibility for access authorization or employment clearance until the next five or ten year reinvestigation depending on the level of security clearance. This could have an adverse effect on the national security.

7. Circumstances Which Justify Variation from OMB Guidelines. There is no variation from OMB Guidelines in this collection of information. Two copies of NRC Form 354 must be submitted to DFS. The original copy is forwarded to the FBI. The second copy is then destroyed upon the return of the original from the FBI.

8. Consultations Outside of the NRC. An opportunity to comment on the information collection requirements was published in the Federal Reaister on February 4,1999 (64 FR 5680). No comments were received.

9. Payment or Gift to Respondents. Not Applicable.

10. Confidentiality of the Information. Tha information is us:d for determining initial and j continuing eligibility for access authorization. The information is protected from public '

disclosure under the Privacy Act of 1974 and is handled in accordance with routine uses specified in the Privacy Act Statement contained on the form.

I 11. Justification for Sensitive Questions. The NRC Form 354 requests information regarding I the applicant's or employee's marriage and identifying information regarding his/her spouse and spouse's parents. This information is essential for identification purposes and to permit NRC to make its determination regarding continued eligibility for access authorization in accordance with appropriate statutes, executive orders, and regulations.

12. Estimate of Burden and Burden Hour Cost. An est; mated 12 minutes is required of each  ;

of the 60 respondents to complete each NRC Form 354, resulting in a total annual I burden to the public of 12 hours1.388889e-4 days <br />0.00333 hours <br />1.984127e-5 weeks <br />4.566e-6 months <br />. The cost to the public is, therefore, expected to be I

$1,452 ($121 x 12 hours1.388889e-4 days <br />0.00333 hours <br />1.984127e-5 weeks <br />4.566e-6 months <br />). The burden estimates are derived from a review of the present usage of the form by employees, contractors, licensees, NRC employment i applicants and others. Therefore, based on this review and a review of the amount of l time it takes the affected individuals to complete the form, it is our belief that these l estimates are reasonable. I NOTE: There is no record keeping requirement for respondents to maintain a copy of the NRC Form 354.

13. Estimate of Other Additional Costs. There are no additional costs.

14. Estimate of Annualized Cost to the Federal Government. The annual cost to NRC of receiving and processing the form is estimated at $541.45. The estimate is based on staff experience in reviewing and handling NRC Fona 354. The cost was computed as follows:

COST:

Annual clerical effort =$ 540.00 (60 reports x .20/hr x $45)

Annual record holding = 1.45 (1/16 cu. ft. X $23.24/cu. ft.)

Total estimated annual cost =$ 541.45 This cost is fully recovered through license fees charged to NRC licensees pursuant to 10 CFR Pads 170 and 171.

15. Beasons for. Chance in Burden. There is no change in burden.

16. Publication for Statistical Use. None.

17. Reason for Not Disolavina the Exoiration Date. Not Applicable.

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18. Exceptions to the Certification Statement. Not Applicable.

B. COLLECTIONS OF INFORMATION EMPLOYING STATISTICAL METHODS j Not Applicable.

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NRC FORM 354 U.S. NUCLEAR REGULATORY COMMIS&lON AF--QVED BY OMB: NO. 31&o4026 LArmts WWWDDmmf pd-YYYY) Enmated burden per response to compy with ths mandatory collection request 12 minutes The informaton costection is needed by NRC to perform in initial secunty check on an alien spouse to assure the respondent is not a security risk Senc comments regarding burden estimate to the Records Management Branch (T4 E6).

u s. Nuc=ar Reguistory Commissen. wasnington. DC 20sss400i. or by intemet DATA REPORT ON SPOUSE e-mail to tys1@nrc Gov. and to the Desk Ofhcer. Ofhce of information and Regulatory Affairs. NEOB 10202. (315o-o026). Ofhce of Management and Budget. Washington, DC 20503 If a means used to impose an informatson collection does not display a currently valid OMB control number, the NRC may not conduct or sponsor. and a person is not required to respond to the information mnection INSTRUCTIONS: This form shall be completed by any applicant who: (a) mames after completing the personnel secunty form (SF 86, "Questionnane for National Securtty Positions"); or (b) marnes after having been granted an access authonzation or employmsnt clearance.

1. NAME OF EMPLOYEE OR APPLlCANT (Last, First, Middle) 2. OTHER NAMES USED BY EMPLOYEE OR APPLICANT (Maiden name and/or other names prevoush used)

3. EMPLOYMENT (Present assignment) 4. DATE AND PLACE OF MARRIAGE

6. PRESENT NAME OF SPOUSE (Last, First. Middle) 6. OTHER NAMES USED BY SPOUSE (Maiden name and/or all other names previously used)

7. DATE AND PLACE OF BIRTH OF SPOUSE 8. PRESENT ADDRESS OF SPOUSE 9 CITIZENSHIP OF SPOUSE: ' A. U S. B. ALIEN C. DUAL (If dual specify countnes)

D. IF U S. CITIZEN. INDICATE WHETHER.

J (1). BY BIRTH (3). BY NATURALIZATION

,. la)~ PETITION NO (b) DATE

; (2). DERIVATIVE Taj~DATE ~-'(b) CERTIFICATE NUMBER (c) CERTIFICATE NUMBER

-~ ~ ~ ~ - -

ic)' PLACE ~ ~~ ~ -~ ~ Ildj ~ PLACE ~ ~ ~ - -

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E. IF ALIEN, INDICATE:

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(iIDATE OF ENTRY ~~' ' ' ' ' ~~ ~7(2) PORT OF ENTRY ' '(3)' ALIEN REGISTRATION NO~ ~~'idi PRESENT CITil.ENSHIP~

10. SPOUSE'S PARENTS -(living or dead)

C. DATE OF E. COUNTRY F. PRESENT A. RELATION B. NAME IN FULL D ADDRESS BIRTH OF BIRTH CITIZENSHIP t

14. SIGNATURE OF EMPLOYEE OR APPLICANT 15. DATE 16. NRC FILE NO. (To be completed by Secunty Office)

NRC FORM 3S4 (MM-YYYY) PRINTED ON RECYCLED PAPER This form was casigned using informs

PRIVACY ACT STATEMENT 'l l

Pursuant to 5 U.S.C. 552a(e)(3), enacted into law by section 3 of the Privacy Act of 1974 (Public Law 93-579), the following statement is furnished to individuals who supply information to the Nuclear Regulatory Commission (NRC) on NRC Form 354. This information is maintained ina system of records designated as NRC-39 and described at 58 Federal Register 36480 (July 71993), or the most recent Federal Register publication of the Nuclear Regulatory Commission's " Republication of Systems of Records Notices" that is available at the NRC Public Document Room, Gelman Building, Lower Level, 2120 L Street NW, Washington, D.C.

1. AUTHORITY. 42 U.S.C. 2165 and 2201(i)(1988); Executive Order 10865; OMB Circular No.

A-130; Federal Personnel Manual 732 and authorities cited therein.

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2. PRINCIPAL PURPOSE (S). Information entered on this form is used as a basis for an investigation to determine your initial or continuing eligibility for NRC employment, access to Restricted Data, National Security information, or special nuclear material; or for access to NRC buildings, access to Federal automated inforrnation systems or data, or for unescorted access to j nuclear power plants or for access to unclassined safeguards information.

3. ROUTINE USES. Information may be used by the Division of Facilities and Security and on a need to-know basis by appropriate NRC officials, Hearing Examiners, Personnel Security Review Examiners, Office of Personnel Management, Federal Bureau of investigation, and other Federal Agencies to determine clearance or access authorization eligibility; to determine eligibility for access to NRC buildings or access to Federal automated informaton systems or data; to certify clearance or access authorization; to provide licensees crimiral history information needed for their unescorted access or access to safeguard informatbn determination. The information may also be disclosed to an appropriate Federal, State, local or Foreign agency in the event the information indicates a violation or rotentialviolation of law and in the course of an administrative or judicial proceeding. In addition, this nformation may be transferred to an appropriate Federal, State, local and Foreign agency to the extent relevant and necessary for an NRC decision about you or to the extent relevant and necessaryfor that i agency's decision about you Information from this form may also be disclosed, in the course of I discovery under a protective order issued by a court of competent jurisdiction, and in presenting evidence, to a Congressional office to respond to their inquiry made at your request, or to NRC-paid experts, consultants, and others under contract with the NRC, on a need-to-know basis.

4.

WHETHER DISCLOSURE IS MANDATORY OR VOLUNTARY AND EFFECT ON INDIVIDUAL OF NOT PROVIDING INFORMATION. Disclosure of this information is voluntary; however, if it is not supplied, your clearance processing may be delayed or your application may not be processed.

5.

SYSTEM MANAGER AND ADDRESS. Director, Division of Facilities and Security, Office of Administration, U.S. Nuclear Regulatory Commission, Washington, DC 20555-0001.

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