ML20261H559

NRC Form 64, Travel Voucher

ML20261H559
Person / Time
Issue date:	10/06/2020
From:	NRC/NMSS/DMSST/ASPB
To:
Meyer K
References
Download: ML20261H559 (4)

Text

NRC FORM 64 U.S. NUCLEAR REGULATORY COMMISSION APPROVED BY OMB: NO. 3150-0192 EXPIRES: (MM/DD/YYYY)

(MM-YYYY)

Estimated burden per response to comply with this voluntary collection request 1 hour1.157407e-5 days <br />2.777778e-4 hours <br />1.653439e-6 weeks <br />3.805e-7 months <br /> for NRC Form 64. NRC uses the information to authorize payment for official travel. Send comments regarding burden estimate to the FOIA, Library, and Information Collections Branch (T-6 A10M), U. S. Nuclear Regulatory Commission, TRAVEL VOUCHER Washington, DC 20555-0001, or by e-mail to Infocollects.Resource@nrc.gov, and the OMB reviewer at: OMB Office of Information and Regulatory Affairs, (3150-0192), Attn: Desk Officer for the Nuclear Regulatory Schedule of Expenses Commission, 725 17th Street NW, Washington, DC 20503; e-mail: oira_submission@omb.eop.gov. The NRC and Amount Claimed may not conduct or sponsor, and a person is not required to respond to, a collection of information unless the document requesting or requiring the collection displays a currently valid OMB control number.

1. Name (Last, First, Middle Initial) 2. Office Telephone Number (Include Area Code) (Enter 10 numeric digits)

3. Mailing Address 4. Is this a new address since you last traveled?

Yes No

5. Do you have Direct Deposit? 6. Travel Begin Date (MM/DD/YYYY) 7. Travel End Date (MM/DD/YYYY)

Yes No

8. Expenses Claimed (From page 2 - Schedule of expenses and amount claimed)

Amount Claimed Expenses Other Expenses A. Subsistence and other expenses (Grand Total from Page 2)

B. Plane, Train, Bus (Paid by Traveler) (If applicable)

C. TOTAL CLAIM

9. I CERTIFY THAT THIS VOUCHER IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND BELIEF AND THAT PAYMENT OR CREDIT HAS NOT BEEN RECEIVED BY ME.

Typed Name of Traveler (Last, First, Middle Initial)

Signature of Traveler

10. THIS VOUCHER IS APPROVED.

Typed Name of Approving Official Signature of Approving Official NRC FORM 64 (MM-YYYY) Page 1 of 3

NRC FORM 64 U.S. NUCLEAR REGULATORY COMMISSION (MM-YYYY)

TRAVEL VOUCHER (Continued)

SCHEDULE OF EXPENSES AND AMOUNT CLAIMED Name (Last, First, Middle Initial) Date (MM/DD/YYYY)

Authorized Mileage (e.g., .50)

Date Nature of Expense Number of Miles Amount Claimed

¢ GRAND TOTAL - THIS PAGE (Amount to be included in Item 8.C, Page 1)

NRC FORM 64 (MM-YYYY) Page 2 of 3

PRIVACY ACT STATEMENT NRC Form 64 Travel Voucher, Schedule of Expenses and Amount Claimed 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 U.S. Nuclear Regulatory Commission (NRC) on NRC Form 64. This information is maintained in a system of records designated as GSA/GOVT4 -

Contracted Travel Services Program and described at 74 Federal Register 26700 (June 3, 2009).

1. AUTHORITY: 31 U.S.C. 3511, 3512, and 3523; 5 U.S.C. Chapter 57; and implementing Federal Travel Regulations (41 CFR Chapters 300-304).

2. PRINCIPAL PURPOSE(S): To make reimbursement claims for approved and authorized travel expenses, per diem, and other change of station expenses

3. ROUTINE USE(S): In addition to the other types of disclosures permitted under subsection of the Privacy Act, information from this system of records may be disclosed:

(a.) to another Federal agency, Travel Management Center (TMC), online booking suppliers, and airlines; to Federal, State, local or foreign agencies when relevant to a potential or actual civil or criminal violation; (b.) To a Federal, State, local, or foreign agency responsible for investigating, prosecuting, enforcing, or carrying out a statute, rule, regulation, or order, where agencies become aware of a violation or potential violation of civil or criminal law or regulation.

(c.) To another Federal agency or a court when the Federal Government is party to a judicial proceeding.

(d.) To a Member of Congress or staff on behalf and at the requests of the individual who is the subject of the record.

(e.) To a Federal agency employee, expert, consultant, or contractor in performing a Federal duty for purposes of authorizing, arranging, and/or claiming reimbursement for official travel, including, but not limited to, traveler profile information.

(f.) To a credit card company for billing purposes, including collection of past due amounts.

(g.) To an expert, consultant, or contractor in the performance of a Federal duty to which the information is relevant.

(h.) To a Federal agency by the contractor in the form of itemized statements or invoices, and reports of all transactions, including refunds and adjustments to enable audits of charges to the Federal Government.

(i.) To a Federal agency in connection with the hiring or retention of an employee; the issuance of a security clearance; the reporting of an investigation; the letting of a contract; or the issuance of a grant, license, or other benefit to the extent that the information is relevant and necessary to a decision.

(j.) To an authorized appeal or grievance examiner, formal complaints examiner, equal employment opportunity investigator, arbitrator, or other duly authorized official engaged in investigation or settlement of a grievance, complaint, or appeal filed by an employee to whom the information pertains.

(k.) To the Office of Personnel Management (OPM), the Office of Management and Budget (OMB), or the Government Accountability Office (GAO) when the information is required for program evaluation purposes.

(l.) To officials of labor organizations recognized under 5 U.S.C. chapter 71 when relevant and necessary to their duties of exclusive representation concerning personnel policies, practices, and matters affecting working conditions.

(m.) To a travel services provider for billing and refund purposes.

(n.) To a carrier or an insurer for settlement of an employee claim for loss of or damage to personal property incident to service under 31 U.S.C. 3721, or to a party involved in a tort claim against the Federal Government resulting from an accident involving a traveler.

(o.) To a credit reporting agency or credit bureau, as allowed and authorized by law, for the purpose of adding to a credit history file when it has been determined that an individual's account with a creditor with input to the system is delinquent.

(p.) Summary or statistical data from the system with no reference to an identifiable individual may be released publicly.

(q.) To the National Archives and Records Administration (NARA) for records management purposes.

(r.) To appropriate agencies, entities, and persons when (1) The Agency suspects or has confirmed that the security or confidentiality of information in the system of records has been compromised; (2) the Agency has determined that as a result of the suspected or confirmed compromise there is a risk of harm to economic or property interests, identity theft or fraud, or harm to the security or integrity of this system or other systems or programs (whether maintained by GSA or another agency or entity) that rely upon the compromised information; and (3) the disclosure made to such agencies, entities, and persons is reasonably necessary to assist in connection with GSA's efforts to respond to the suspected or confirmed compromise and prevent, minimize, or remedy such harm. For additional detail on these routines uses, please see the GSA/GOVT-4 system notice.

4. WHETHER DISCLOSURE IS MANDATORY OR VOLUNTARY AND EFFECT ON INDIVIDUAL OF NOT PROVIDING INFORMATION: Disclosure is voluntary. However, if the requested information is not provided, reimbursement may be denied.

5. NRC CONTACT AND ADDRESS INFORMATION: Chief, Travel Operations Branch, Division of the Controller, Office of the Chief Financial Officer, U.S. Nuclear Regulatory Commission, Washington, DC 20555-0001.