ML20236B662

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

ML20236B662
Person / Time
Issue date:	03/10/1989
From:	Amenta J NRC
To:
References
OMB-3150-0049, OMB-3150-49, NUDOCS 8903210215
Download: ML20236B662 (7)

Text

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- StandFd fbrm 83

' Request for ONJB  : .. -Review %&C n.~-easw - -.

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Read instruct: ens before completrg form Do not use the same SF 83 . Send three copies of this form, the material to be reviewed, and for.

to reqJest botn an Executive Order 12291 review and aoprovat under , paperwork-t'iree copies of the supporting statement, to - l the Paperwork Pexcticn Act ' i Anuer ail cuest c s n Part I.'ll this requ ot is for review unde' E.O. Office of Information and Regulatory Affairs j

'12291 ccTp'ete Part !! arid sign the repf atory certif cation. If thts Office of Management and Budget

reosest is for acc*ovat under the Pacer,sork Reduction Act and 5 CFR Attention

Docket Ubrary, Room 3201

- 1320. sup Puni compiete Part ist ar;d s gn the paperwork certification. Washington. DC 20503

, PART l.-Complete This Part for All Requests.

1. Deprtment,apfoci and Bde JiOthce Of@fGt;rg; req'Jesi 2. Agency coce -

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PART II.-Complete This Part only >( the Request is for O*AB Review Under Executive Order 12291 _

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.ofInformation Under the Paperwork Reduction Act and 5 CFR 1320.-

. fineactuen:UL asa,ea eceepaewnmeremeis~" n Security Classified ' ecords,- R Access Authorization.

! Termination". -The NRC' Form 136 affects the employees of licensees and' contractors.who'have ubeen granted an NRC access authorization. -When the access authorization is no longer needed, Ethe. executive of the form apprises. the respondent of their continuing security responsibilities

.and is used to initiate. termination of the access authorization.

14. iype of mfc"naScr rMt on f cyc4 xiyre) inforr1ation collections not conta'ned in rules

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hformation collections containedin r&*

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25. Are tr e resswcents pmam, escat>onat agene es or inst tutrons or is the or' mary c;rpose of tna criect.on related to Federal education p egrams? Yes @ No

' 26. Does tre asercy ute tr P ng13 % ect respondents or d:es tFe agercy recr/rreend or preser be the use cf samphng er stat'stica! ana!ysis

.by resserdents? . C ves S uo

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1 r Date Lgr ature r d e sc, reec trek odc* or an a +c ce: represe-tatne Ih cA 7 Joyc . menta, DSO for Information Resources Management I J

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OM8 SUPPORTING STATEllENT FOR NRC FORll 136 Security Termination Statement Description of Information Collection The reporting requirements associated with the NRC Form 136, " Security Termination Statement," affects the employees of approximately 22 licensees and 35 contractors who have been granted an NRC access authorization (security clearance). 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 pertinent 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 flRC Form 136 is to be forwarded to NRC Headquarters, Division of Security (SEC), 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 af ter 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.

A. JUSTIFICATION

1. Need for the Collection of Information.

Section 5.3 of Executive Order 12356 requires agencies to

... establish procedures to prevent unnecessar information, including procedures that...(ii) y access ensure that theto classified 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 complet-ed NRC Form 136 is to be forwarded by the licensee / contractor to NRC

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l Headquarters Division of Security (SEC) who uses the information in ,

connection with the termination of the respondent's access authoriza- i tion. In addition to providing assurance of HRC compliance with ,

E.0. 12356, the NRC Form 136.is the vehicle used by SEC to apprise 4 the individual of his/her continuing responsibilities for protecting .l classified information that he/she had access to in the course of performing official duties. The individual's signature on this form indicates their acknowledgement / acceptance of these continuing responsibilities. Failure to use the NRC Form 136 by the licensee /

contractor may result in: (1) failure to terminate the NRC access-authorization when circumstances dictate and, therefore continued ,

access to classified information; and (2) the individual not being 1 apprised of, or officially acknowledging (by signature) his/her I continuing responsibilities for protecting classified information. i Reduction of Burden Through Information Technology.

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3.

No reduction in the information collection b-urden 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 Hanagement 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 related 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 identified in item 4 above, there is no similar information collection made by NRC.

6. Effort to Reduce Small Business Burden.

None of the licensees affected by the use of the NRC Form 136 qualify 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 enterprise or entity.

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7.- Consequences of Less Frequent Collection.

The frequency of information collectiorp is limited to circumstances a .When the respondent's NRC access authorization is.to be terminated.  !

In most cases,1a less frequent collection would mean eliminating the  !

collection, as:the. access authorizations of contractor / licensee-

. employees are not frequently granted / terminated on a reoccurring 4 basis. If the information is not collected, the assurance that'only

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appropriately cleared individuals 'have access to classified information 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. Circumstance's Which Justify Variation from OMB' Guidelines.

There is no variation from OMB Guidelines in.the collection of information. ,

9.: ' Consultations Outside the NRC.

.No consultati ons have been held since the submittal of the last .;

clearance package.

10. , Confidentiality of the Information.

The information collected is used to terminate a respondent's.NRC- l access authorization. The completed NRC From 136 contains no information of a confidential or personal nature and would not fall-under the exemptions of the Privacy Act of 1974. Upon specific request, the form would be made available for public'insp'ection in accordance with 10 CFR Part 9.

11. Justification for Sensitive Questions.

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

12. Estinated Annualized Cost to the Federal Government. .

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

i NOTE: Annual form usage 400 (10% of the approximately 4,000 access l autho'rizations held by licensees / contractors). j L

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COST: 7 i

Annual clerical effort = $533.40 (400X4.00 minutes =26.67h'rs.'X$20/hr.) '

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s. 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

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13. Estimate of Buroen.-

An estimated six minutes (based on staff experience) is required'to )

complete each NRC form 136, resulting in a total annual burden on j the publ_ic 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 responses (10% of the approximately 4,000 access.

X 6.0 minutes authorizations completion time held each by licensees

40.00 hours/burden contractors)$60.00 X per hour

$2,400.00.

NOTE: There is no recordkeeping requirement / burden upon the contractors / licensees in that the completed NRC Form 136 is to be

, forwarded to the NRC and no requirement exists to maintain a copy.

14. Reasons for Changes in Burden.

There has been no change in the burden on the public associated with -]

the completion of NRC Form 136. )

l Publications for Statistical use.

15. ,

t There is no application of statistics on the information collection  !

related to the NRC Form 136. There also is no publication of the j information.  !

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. ea .V U.S. NUCLEQR REGULAToHV CoMMISSloN ] ^

NRC eOcu 136 1 ;ms," ***

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'd PAnil V & Vi SECURITY TERMINATION STATEMENT L MP LO V i R NAM $ (P,ini 4,# 4eme, earteci, Wi esme, was weaWI t f F E CTivi D Af( OF IL AWN ATION NRC ACCE $$ AUTMORIZ ATION FILE hrVM8tm(#1anown/  !

I make the following statement in connection with the termination of my access authorization granted by, or pending with, the U.S. Nuclear Regulatory Commission (NRCh

1. I shall not unlawfully reveal to any person any National Security Information, Restricted Data, or other classified information, or unclassified Safeguards Information of which I may have gained knowledge except as authorized by law, regulations of the NRC, or in writing by officials of the NRC empowered to grant permission for such disclosure. i

2. I am aware that the Atomic Energy Act of 1954, as amended, and U.S. Code, Title 18, " Crimes and Criminal Procedures," prescribe penalties for unauthorized disclosure of Restricted Data, Formerly Restricted Data, Safeguards Information, and other information relating to the national defense, y I

3. I am aware that, unless and until I am released in writing by an authorized representative of the U.S. f Government, all conditions and obligations imposed upon me by virtue of my having executed SF 189, i

" Classified InformatioiiNondisclosure Agreement," rerhain in full force and effect.

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4.- I am aware that I may be liable f or damages if I reveal to any unauthorized person sensitive unclassified 1 information (e.g., privacy information, proprietar,y information) of which I have gained knowledge as a

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result of my employr'nent/ affiliation with NRC.;i ' .,

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5. I have destroyed, in accordance with NRC security regulations or transferred to persons designated by the N RC, all classified and/or sensitive unclassified information which I may have had in my possession.

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

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7. I understand that the NRC desires to be informed when persons who have been granted an NRC access authorization propose to travel to Communist controlled countries within 2 years from execution of this form. This does not apply to individuals who obtain an NRC access authorization and receive access to NRC classified information solely as employees of other Government agencies or their contractors.

SIGN ATURE - PER$0N IR ECUTING TMl8 FORM

$lGN ATURE - PERSON CONOUCTING smitstNQ DAf t AND Pt ACE WHERE SIGNED EMPLOY {R OF PERSON CONOUCTING SRIEFING AND TITLE Of POSdTION HILD A'G pfT"8 NCH IP 430; N 8UR I TsMA f1 THE R CO of A 0 1 M@ b'N AR C MENT 8REO "

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