ML21075A335
| ML21075A335 | |
| Person / Time | |
|---|---|
| Issue date: | 03/18/2021 |
| From: | James Rubenstone NRC/NMSS/DFM/MCAB |
| To: | |
| MShoemaker - NMSS/DFM/MCA - 301.415.7363 | |
| Shared Package | |
| ML21075A325 | List: |
| References | |
| Download: ML21075A335 (1) | |
Text
DOE/NRC FORM 740M U. S. DEPARTMENT OF ENERGY APPROVED BY OMB: NO. 3150-0057 EXPIRES: 04/30/2021 (04-2018) AND Estimated burden per response to comply with this mandatory collection request: 45 minutes. This information is required to satisfy the provisions of the US/
MANDATORY DATA COLLECTION U. S. NUCLEAR REGULATORY COMMISSION IAEA Safeguards Agreement. Send comments regarding burden estimate to the Information Services Branch (T-2 F43), U.S. Nuclear Regulatory Commission, AUTHORIZED BY 10 CFR 30, 40, Washington, DC 20555-0001, or by e-mail to Infocollects.Resource@nrc.gov, and to the Desk Officer, Office of Information and Regulatory Affairs, 50, 70, 72, 74, 75, 150 Public Laws83-703, 93-438, 95-91 CONCISE NOTE NEOB-10202, (3150-0057), Office of Management and Budget, Washington, DC 20503. If a means used to impose an information 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 collection.
- 1. Name 2. Attachment To: 3. RIS 4. Reporting Period (MM/DD/YYYY)
A. DOE/NRC 741 B. DOE/NRC 742 C. DOE/NRC 742C From Date To Date Street Address 5. Transaction Data
- 6. Reporting Date A. B. C. D.
E. PC F. AC Shipper's RIS Receiver's RIS Transaction Num. Correction Num.
City State Zip Code 7B. Entry 7A. Line No. 7C. Text of Concise Note Reference To the best of my knowledge and belief, the information given above and in any attached schedules is true, complete, and correct.
- 8. Signature (See instructions [NUREG/BR-0006] for provisions regarding confidentiality). 9. Title 10. Date WARNING: FALSE STATEMENTS IN THIS CERTIFICATE MAY BE SUBJECT TO CIVIL AND/OR CRIMINAL PENALTIES. NRC REGULATIONS REQUIRE THAT SUBMISSIONS TO THE NRC BE COMPLETE AND ACCURATE IN ALL MATERIAL RESPECTS.
18 U.S.C. SECTION 1001 MAKES IT A CRIMINAL OFFENSE TO MAKE A WILLFULLY FALSE STATEMENT OR REPRESENTATION TO ANY DEPARTMENT OR AGENCY OF THE UNITED STATES AS TO ANY MATTER WITHIN ITS JURISDICTION.
DOE/NRC FORM 740M (04-2018)