ML20214Q161

Request for OMB Review & Supporting Statement Re NRC Form 354, Data Rept on Spouse. Estimated Respondent Burden Is 22 H

ML20214Q161
Person / Time
Issue date:	11/28/1986
From:	Norry P NRC OFFICE OF ADMINISTRATION (ADM)
To:
References
OMB-3150-0026, OMB-3150-26, NUDOCS 8612050011
Download: ML20214Q161 (9)

Text

m pu anom m, 5""'"" '", s 3 Request for OMB Reviews.-. -

h (Rev Septemtm 198?)

Important R;ad instructions before completing form. Do not use the same SF 83 Send three copies of this form, the material to be reviewed, and for to request both an Executive Order 12291 review and approval under paperwork-three copies of the supporting statement, to.

the Paperwork Reduction Act.

AnswIr all questions in Part 1. If this request is for review under E.O.

Office of Information and Regulatory Affairs 12291, complete Part il and sign the regulatory certification. If this Office of Management and Budget request is for approval under the Paperwork Reduction Act and 5 CFR Attention: Docket Library, Room 3201 1320, skip Part II, complete Part ll1 and sign the paperwork certification.

Washington, DC 20503 PART 1.-Complete This Part for All Requests.

1. Department / agency and Bureau /of fice onginating request

2. Agency code U.S. Nuclear Regulatory Commission Office of Administration Division of Security 1 1-5_ A_

3. Name of person who can best answer questions regarding this request Telephone number Richard A. Dopp

( 202 )492-4124

4. Title of information collection or ruiemaking NRC Fonn 354, " Data Report on Spouse"

5. Legal sutnonty for informatson collection or rule (cate Unoted States Ccce. PubIrc law, or Executive Order) 42 usc 2201(c)

Executive Orders 10450,10865. and 12356

. or

6. Affected pubhc(chtch allthatapply) 5 0 rederaiagenciesorempioyees 1 $ Individualsorhouseholds 3 0 rarms e O Non-profitinstitutions 2 O stateoriocaigovernments 4 O Businesses or other for-profit 7 0 smaii businesses or organizations PART ll.-Complete This Part Only if the Request is for OMB Review Under Executive Order 12291

7. Reguiltion Identifier Number (RIN)

_ _ _ _ ~ _

_ __ __. or, None assigned O

8. Type of submussion (check one on each category)

Type of review requested CIsssification Stage of development 1 O standard i O Major i O proposedordraft 2 O Pending 2 O Nonmajor 2 O rinaiorintenmfinai.withonorproposai 3 O Emergency 3 0 rinai or inter n finai. without enor proposai 4 O statutoryorjudiciaideadhne

9. CFR section affected CFR

10. Does this reFulation contain reporting or recordkeeping requirements that require oMB approvat under the Paperwork Reduction Act and 5 CFR 1320?

. O yes O No

11. lf a major rule,is there a regulatory impact analysis attached?

1 O Yes 2 O No if"No," did OMB warve the analysis) 3 0 ves 4 0 No Ccrtification for Regulatory Submissions in submitting this request for OMB review, the authonzed regulatory contact and the program official certify that the requirements of E O.12291 and any applicable policy directives have been comphed with.

senatura of program official Cate signature of authorized regulatory ContaCl 8612050011 861128 PDR ORG EUSOMB Date PDR

12. (OMB use only)

Prwoous editions obsolete 83t08 NSN 7540-00-6344034 r

O O 5 CFR 1320 and E O 12291

? ART lil.-CompletaThis P:rt Cnly if the R: quest is for Appr:v:1 cf a C:ll:ctlIn of Information Under the P;perwork Reducti"n Act rnd 5 CFR 1320.

13. Abstrict-Describeneces.usesandaffectedpueiicinSowardsoriess " Federal employee and work 1_ngplace safety" NRC Form 354 is completed by NRC contractors, licensee applicants, and employment applicants who are married to alien spouses; marry alien spouses after submission of the Personnel Security Questionnaire; or after receiving an access authorization or employment clearance. Respondents character and associations are investigated, reported and detemined to ensure access authorized personnel will not endanger enmmon_ defense anri cafety.

14. Type of information cotiection (check only one)

Information collections not containedin rules 1 $ Regular submission 2 O Emergency submission (cerfehcationattached)

Lformation collections contained in rules 3 O Existins resuiation (no change proposed) 6 rinai or intenm finai without enor NeRu

7. Enter date of e,pected or actuai rederai 4 O Notice of proposed rulemaking(NPRM)

A O Regularsubmission Register pubhcation at this stage of rulemaking 5 O Final. NPRM was previously pubhshed B O Esnergency submission (certehcation attached)

(month, day. year);

15. Type of review requested (check only one) 1 O New collection 4 O Reinstatement of a previousiy approved coiiection for wnich approvai 2 O Revision of a currently approved collection has expired 3 @ Extension of the expiration date of a currently approved cofiecton 5 O Existing collection in use without an oMB control numt'er without any change in the substance or in the method of collection

16. Agency teport form number (s)(onclude standard /optionalform number (s))

22. Purpose of intormation collection (check as many as apply) 1 O Application for benefits NRC Fom 354 2 O Program evaiuation

17. Annati reporting or disclosure burden 3 0 ceneraipurposestatistics 1 Number of respondents.

88 4 3 Regulatoryorcomphance 2 Number of responses per respondent 1

5 O Program planr.ing or management 3 Total annual responses (line 1 times hoe 2) 88 6 O Research 4 Hcurs per response

.25 7-0 Audit 5 Totrl hours (hne 3 times hoe 4) 22

18. Annual recordkeeping burden

23. Frequency of recorckeeping or reporting r heck allthatapply) c 1 Number of recordkeepers 1 O Recordkeeping 2 Annual hours per recordkeeper.

Reporting 3 Total recordkeeping hours (hne 1 times hne 2) 2 @ onoccasion 4 Recordkeeping retention panod years 3 0 weekiy

19. Totit cnnual burden 4 O Montniy 1 Ret.aested (kne 17-5 plus hne 18-3).

22 5 0 quarter 1y 2 in current oMB inventory 22 6 O semi-annuaiiy 3 Diffirence (Isne 1/ess hne 2) 0 7 O Annuatiy Esplanation of differena a O e,ennialsy 4 Program change 9 0 otnerrdesenb ).

5 Adjustment.

20. Current (most recent) oMB control number or comment nurnber

24. Respondents' obhgation to comply (check the strongest obigation that apphes) 3150-0026 1 O vorontary

21. Requested expiration date 2 O Required to obtain or retain a benefit Three vcars from CMB aoproval date 3 00 Mandatory

25. Ara the respondents pnmanly educational agencies or institutions or is the pnmary purpose of the t.otlection related to Federal education programs? O ves 0 No

26. Does the agency use samphng to select respondents or does the agency recommend or presenbe the use of samphng or statistical analysis by respondents.

. O ves 0 No

27. Regulatory authonty for the information collection 10 cFR s25.21(bI

or FR

or,other (specify):

Paperwork Certification in submittmg this request for oMB approvat, the agency head the senior official or an authorized representative. certifies that the requirements of 5 CFR 1320. the Prreacy Act, stat stical standards or directives, and any other apphcable information pol.cy direct..es have been comphed with.

Signitura of program off.cial Date Lgnaturatf agency b

d. the senior official or an authonzed representative Date Patricia y, Directo ff ce of Administration 11/dh86

1. GPO e 1984 0 - 453-776.

i 1

OMB SUPPORTING STATEMENT FOR NRC FORM 354

" DATA REPORT ON SP0USE" Description of Information Collection. This reporting requirement affects approximately 88 individuals annually. The respondents are NRC contractors, NRC licensee applicants, and NRC employment applicants who are applying for NRC access authorization or employment clearance and are married to aliens.

The form must be completed by respondents who marry an alien after completing the Personnel Security Questionnaire, or after having been granted an NRC access authorization or employment clearance.

A. Justification 1.

heed for 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 determi-nation that permitting such a person access to RD will not endanger the common defense and security.

1

Data Report The basic security standard of Executive Order 10450, " Security Requirements for Government Employment," for employment, or retention of an individual in 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) "... only upon finding that it is clearly consistent with the national interest to do so."

10 CFR Part 10, Subpart B, " Criteria and Procedures for Determining Eligibility for Access to Restricted Data or National Security I

Information or an Employment Clearance," provides criteria to assist in making this determination.

In order for NRC to implement this responsibility, it is pertinent, from a security standpoint, that NRC receive infonnation concerning (I) alien spouses of NRC applicants; (2) alien spouses of NRC contractor and licensee employees pending NRC access authorization processing; (3) spouses of NRC applicants, contractor or licensee employees who marry after applying for NRC access authorization; and (4) spouses of NRC contractor and NRC licensee employees who marry after having been granted NRC access authorization.

1 I

i i

Data Report,

2. Agency Use of Information. The information supplied identifies the respondent, his/her spouse, spouse's citizenship, and data on the spouse's relatives. This information permits an initial security determination by the NRC Division of Security as to 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. A copy of the completed form is sent to the Federal Bureau of Investigation (FBI) where a name check on FBI files is completed.

In the case of alien spouses and relatives, appropriate checks at I

other appropriate Government agencies may also be completed. The results of the completed FBI and other agency checks are returned i

to the NRC Division of Security whereupon a second evaluation /

determination is made, based on any developed information, as to whether it has any impact on the respondent's initial or continued eligibility for access authorization or an employment clearance.

3. Reduction of Burden Through Information Technology. Because the information is required of individuals and not of corporations or businesses, the chances are very slim for reducing the burden,15 minutes per respondent, through information technology.

Data Report 4. Effort to Identify Duplication.

In a few instances, portions of the needed information might also be contained in other information submitted to the NRC or other Federal Agencies. However, duplication, if any, is slight and the collection of the information by use of the NRC Form 354 is considered the most effective and least burdensome means of obtaining the needed information.

5. Effort to Use Similar Information.

No similar information exists.

As with other personal information required from an individual applying for or possessing an NRC access authorization, this too must be supplied by the individual. No alternative sources are available.

6. Effort to Reduce Small Business Burden. None of the licensees, organizations, or persons affected qualify as small businesses.

7. Consequences of Less Frequent Collection. There is no established reporting frequency or period for NRC Form 354. This form is used whenever an applicant for NRC access authorization is married to an alien, marries after completing a Personnel Security Question-nairo, or when an access authorized individual marries.

8.

Circumstances Which Justify Variation from OMB Guidelines. There is j

no variation from OMB Guidelines in this collection of information.

Data Report 9. Consultations Outside the NRC.

No consultations.

10. Confidentiality of the Information. The information is used for determining initial and continuing eligibility for access authori-zation. 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.

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

12. Estimated Annualized Cost to the Federal Government. The annual cost to NRC of receiving and processing the form is estimated at $1,320 (88 reports x.25/hr x $60),

13. Estimate of Burden. An estimated 15 minutes is required of each of the 88 respondents to complete each NRC Form 354, resulting in a total annual burden to the public of 22 hours2.546296e-4 days <br />0.00611 hours <br />3.637566e-5 weeks <br />8.371e-6 months <br />.

Data Report The burden estimates are derived from a review of the present usage of the form by contractors, licensees, and NRC employment applicants.

Therefore, based on this review and a review of the amount of time it takes the affected individuals to complete the form, it is our belief that these estimates are considered reasonable.

14. Reason for Changes in Burden. There has been no change in the burden on the public associated with the completion of NRC Form 354, since the current OMB approval.

15. Publication for Statistical Use. Two copies of NRC Form 354 must be submitted to NRC Division of Security. The original copy is forwarded to the Federal Bureau of Investigation (FBI). The second copy is retained in the NRC personnel security file until the original is returned to NRC. The second copy is then destroyed. There is no application of statistics on the information collection related to the NRC Form 354. There also is no publication of the information.

1

i NRC Form W4 Approved Dy OMS I

3['f,j,02 UNITED STATES NUCLEAR REGULATORY COMMISSION g,

2 29 a7 DATA REPORT ON SPOUSE INSTRUCTIONS - This form shall be completed by: (a) persons who marry after the time they submit NRC Form 1,

" Personnel Security Questionnaire," as applicants for security clearance, or access authorization, (b) appi: cants for clearance or access authorization who are married to aliens.

1. NAME OF EMPLOYEE OR APPLICANT (Last, First, Middle)

2. OTHER NAMES USED BY EMPLOYEE OR APPLICANT (Maiden name and/or other names previously used)

3. EMPLOYMENT (Present assignment)

4. DATE AND PLACE OF MARRIAGE

5. PRESENT NAME OF SPOUSE (Last, First, Middle)

6. OTHER NAMES USED BY SPOUSE (Maiden nome and/or all other names previously used)

7. DATE AND PLACE OF BIRTH OF SPOUSE

8. PRESENT EMPLOYMENT OF SPOUSE (Name ord location)

OR LAST PREVIOyS EMPLOYMENT s

9. PRESENT ADDRESS OF SPOUSE

10. LAST PREVIOUS ADDRESS OF SPOUSE

11. CITIZENSHIP OF SPOUSE.

U.S.

DUALU(if dual,specify countries)

ALIEN IF U.S. CITIZEN, INDICATE WHETHER:

IF ALIEN, INDICATE ALIEN REGISTRATION NO.

(A) BY BIRTH O

(C) BY NATURAllZATION O (B) DERIVATIVEO PETITION NO.

(A) DATE OF ENTRY (C) PRESENT CITIZENSHIP DATE DATE E

CERTIFICATE NO.

CERTIFICATE NO.

(B) PORT OF ENTRY PLACE PLACE

12. MILITARY SERVICE OF SPOUSE (Past or present)

COUNTRY SERIAL NO.

BRANCH FROM (YR.)

TO (YR.)

13. SPOUSE'S RELATIVES (Parents, drvorced spouse or spouses, children, brothers, sisters, stepbrothers, stepsesters, half brothers, half sisters, living or dead)

U^IE PR T

RELATION NAME IN FULL ADDRESS cOuN Y OF g,n e

14. SIGNATURE OF EMPLOYEE OR APPLICANT DATE NRC FILE NO. (To be filled in by Security Office)

NAC FORM 354 (146)