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Category:Report
MONTHYEARML24179A0482024-06-27027 June 2024 Final SS for Generic Customer Satisfaction Fast-Track ML23206A1922024-02-0505 February 2024 OMB 3150-0206, Draft Supporting Statement for Identity, Credential, and Access Management (Icam) System ML24016A0022024-02-0101 February 2024 OMB 3150-0053, Final Supporting Statement for 10 CFR Part 4 ML23332A0462024-01-0505 January 2024 OMB 3150-0158, Draft Supporting Statement, 10 CFR 36, Licenses and Radiation Safety Requirements for Irradiators ML23312A0372023-12-0404 December 2023 Final Supporting Statement for Grants and Cooperative Agreement Provisions ML23137A3782023-10-17017 October 2023 OMB 3150-0053 Draft Supporting Statement for 10 CFR Part 4 ML23156A2412023-09-28028 September 2023 10 CFR Part 63- 60-day Supporting Statement 2023 ML23194A1352023-09-0707 September 2023 OMB 3150-0007, Final Supporting Statement for 10 CFR Part 34, Licenses for Radiography and Radiation Safety Requirements for Radiographic Operations ML23158A0812023-08-28028 August 2023 OMB 3150-0107, Draft Supporting Statement for Grants and Cooperative Agreement Provisions ML23158A0932023-08-28028 August 2023 Standard Terms and Conditions for U.S. Nongovernmental Recipients ML23125A0742023-08-16016 August 2023 OMB 3150-0104, Final 2023 Collection Renewal NRC Forms 366, 366A, 366B, Licensee Event Report Supporting Statement ML23192A1032023-07-26026 July 2023 U.S. Nuclear Regulatory Commission, Sustainability Report and Implementation Plan Fy 2023 ML23130A0402023-07-12012 July 2023 OMB 3150-0190, Final Supporting Statement for NRC Form 629, Authorization for Payment by Credit Card ML23107A1602023-06-26026 June 2023 Draft 2023 SS for 3150-0223 NRC Form 749 LVS Clean ML23144A2402023-06-16016 June 2023 OMB 3150-0033, Final Supporting Statement for NRC Form 212 Final Supporting Statement ML23072A1562023-04-12012 April 2023 OMB 3150-0246 Draft Supporting Statement for CUI Challenge Request 2023 ML22271A8622023-03-24024 March 2023 OMB-3150-0017 Final Supporting Statement for 10 CFR Part 30 Rules of General Applicability to Domestic Licensing of Byproduct Material ML22243A0072023-02-17017 February 2023 Rulemaking-Proposed Rule-OMB Supporting Statement, American Society of Mechanical Engineers Code Cases RG 1.84 Rev 40, RG 1.147 Rev 21, RG 1.192 Rev 5, and Revision of Inservice Inspection and Inservice Testing Code of Record Frequency Upda ML22339A0892023-02-0808 February 2023 OMB 3150-0218 Final Supporting Statement for NRC Form 850 Request for Contractor Assignment(S) ML23023A2362023-01-26026 January 2023 Final Supporting Statement for Form 327 OMB Clearance ML22341A0832023-01-0303 January 2023 Final Supporting Statement for NRC Form 277 Request for Visit ML22318A1272023-01-0303 January 2023 Final OMB Supporting Statement: NRC Form 314 ML22342B2032023-01-0303 January 2023 Final Supporting Statement for NRC Form 237 - Request for Access Authorization (3150-0050) ML22353A0952022-12-19019 December 2022 Draft Supporting Statement for Privacy Act Complaint Form 974 ML22347A3172022-12-15015 December 2022 OMB 3150-0217, Final Supporting Statement for Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery ML22220A2312022-09-12012 September 2022 2022 Final Supporting Statement NRC Form 244 ML22192A0942022-08-30030 August 2022 OMB 3150-0218 Draft Supporting Statement for NRC Form 850, Request for Contractor Assignment(S) ML22200A1122022-08-25025 August 2022 Draft Supporting Statement for 10 CFR Part 25 Access Authorization (3150-0046) ML22217A0342022-08-0505 August 2022 2022 Q2 Report to Department of Justice ML22217A0352022-08-0505 August 2022 2022 Q3 Report to Department of Justice ML22153A1092022-08-0303 August 2022 Final Supporting Statement for NRC Form 748 2022 National Source Tracking System Report ML22158A0992022-06-0707 June 2022 Final Supporting Statement for NRC Form 176, Security Acknowledgment and Termination Statement ML22006A2522022-03-30030 March 2022 OMB Draft Supporting Statement: NRC Form 176, Security Acknowledgement and Termination, (3150 0239) ML21356A8672022-03-22022 March 2022 Draft Supporting Statement for NRC Form 748 2022 National Source Tracking Transaction Report - Renewal ML21245A0712021-10-0101 October 2021 OMB 3150-0188, Draft Supporting Statement, NRC Form 531, Request for Taxpayer Identification Number ML21173A0712021-07-19019 July 2021 Final Supporting Statement for 10 CFR Part 31, (3150-0016), 2021 Information Collection Renewal ML21078A4752021-03-19019 March 2021 2020 Records Management Self-Assessment Report ML21056A4202021-02-25025 February 2021 2021 Chief FOIA Officer Report ML20240A1512020-09-29029 September 2020 OMB 3150-0121, 2020 Final Supporting Statement 10 CFR Part 81, Standard Specifications for the Granting of Patent Licenses ML20160A3922020-06-12012 June 2020 2020 Final Supporting Statement IAEA May 2020 ML20105A0732020-05-19019 May 2020 OMB 3150-0007, Final Supporting Statement for 10 CFR Part 34 Licenses for Radiography and Radiation Safety Requirements for Radiographic Operations ML20126G4642020-05-0505 May 2020 Supporting Statement for Part 55 Exemption Request Online Forms ML20055D9592020-03-0606 March 2020 2019 Chief FOIA Officer Report ML20055D8602020-02-19019 February 2020 2020 Chief FOIA Officer Report ML19233A0652019-10-0707 October 2019 OMB 3150-0164, Final Supporting Statement for NRC Forms 540 and 540A ML19240A3772019-10-0707 October 2019 OMB 3150-0165, Final Supporting Statement for NRC Forms 542 and 542A ML19240B7152019-10-0707 October 2019 OMB 3150-0166, Final Supporting Statement for NRC Forms 541 and 541A ML19113A0972019-09-30030 September 2019 Requests to Federally Recognized Tribes for Infomation, Draft Support Statement (OMB 3150-XXXX) ML19177A1262019-09-18018 September 2019 OMB 3150-0028 Draft Supporting Statement Form 314 ML19161A2952019-07-0808 July 2019 Draft OMB Supporting Statement for NRC Form 327 2024-06-27
[Table view]Some use of "" in your query was not closed by a matching "". Category:Miscellaneous
MONTHYEARML24179A0482024-06-27027 June 2024 Final SS for Generic Customer Satisfaction Fast-Track ML23206A1922024-02-0505 February 2024 OMB 3150-0206, Draft Supporting Statement for Identity, Credential, and Access Management (Icam) System ML24016A0022024-02-0101 February 2024 OMB 3150-0053, Final Supporting Statement for 10 CFR Part 4 ML23312A0372023-12-0404 December 2023 Final Supporting Statement for Grants and Cooperative Agreement Provisions ML23137A3782023-10-17017 October 2023 OMB 3150-0053 Draft Supporting Statement for 10 CFR Part 4 ML23156A2412023-09-28028 September 2023 10 CFR Part 63- 60-day Supporting Statement 2023 ML23194A1352023-09-0707 September 2023 OMB 3150-0007, Final Supporting Statement for 10 CFR Part 34, Licenses for Radiography and Radiation Safety Requirements for Radiographic Operations ML23158A0812023-08-28028 August 2023 OMB 3150-0107, Draft Supporting Statement for Grants and Cooperative Agreement Provisions ML23158A0932023-08-28028 August 2023 Standard Terms and Conditions for U.S. Nongovernmental Recipients ML23125A0742023-08-16016 August 2023 OMB 3150-0104, Final 2023 Collection Renewal NRC Forms 366, 366A, 366B, Licensee Event Report Supporting Statement ML23192A1032023-07-26026 July 2023 U.S. Nuclear Regulatory Commission, Sustainability Report and Implementation Plan Fy 2023 ML23130A0402023-07-12012 July 2023 OMB 3150-0190, Final Supporting Statement for NRC Form 629, Authorization for Payment by Credit Card ML23107A1602023-06-26026 June 2023 Draft 2023 SS for 3150-0223 NRC Form 749 LVS Clean ML23144A2402023-06-16016 June 2023 OMB 3150-0033, Final Supporting Statement for NRC Form 212 Final Supporting Statement ML23072A1562023-04-12012 April 2023 OMB 3150-0246 Draft Supporting Statement for CUI Challenge Request 2023 ML22271A8622023-03-24024 March 2023 OMB-3150-0017 Final Supporting Statement for 10 CFR Part 30 Rules of General Applicability to Domestic Licensing of Byproduct Material ML22243A0072023-02-17017 February 2023 Rulemaking-Proposed Rule-OMB Supporting Statement, American Society of Mechanical Engineers Code Cases RG 1.84 Rev 40, RG 1.147 Rev 21, RG 1.192 Rev 5, and Revision of Inservice Inspection and Inservice Testing Code of Record Frequency Upda ML22339A0892023-02-0808 February 2023 OMB 3150-0218 Final Supporting Statement for NRC Form 850 Request for Contractor Assignment(S) ML23023A2362023-01-26026 January 2023 Final Supporting Statement for Form 327 OMB Clearance ML22341A0832023-01-0303 January 2023 Final Supporting Statement for NRC Form 277 Request for Visit ML22318A1272023-01-0303 January 2023 Final OMB Supporting Statement: NRC Form 314 ML22342B2032023-01-0303 January 2023 Final Supporting Statement for NRC Form 237 - Request for Access Authorization (3150-0050) ML22353A0952022-12-19019 December 2022 Draft Supporting Statement for Privacy Act Complaint Form 974 ML22347A3172022-12-15015 December 2022 OMB 3150-0217, Final Supporting Statement for Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery ML22220A2312022-09-12012 September 2022 2022 Final Supporting Statement NRC Form 244 ML22192A0942022-08-30030 August 2022 OMB 3150-0218 Draft Supporting Statement for NRC Form 850, Request for Contractor Assignment(S) ML22200A1122022-08-25025 August 2022 Draft Supporting Statement for 10 CFR Part 25 Access Authorization (3150-0046) ML22217A0342022-08-0505 August 2022 2022 Q2 Report to Department of Justice ML22217A0352022-08-0505 August 2022 2022 Q3 Report to Department of Justice ML22153A1092022-08-0303 August 2022 Final Supporting Statement for NRC Form 748 2022 National Source Tracking System Report ML22158A0992022-06-0707 June 2022 Final Supporting Statement for NRC Form 176, Security Acknowledgment and Termination Statement ML22006A2522022-03-30030 March 2022 OMB Draft Supporting Statement: NRC Form 176, Security Acknowledgement and Termination, (3150 0239) ML21356A8672022-03-22022 March 2022 Draft Supporting Statement for NRC Form 748 2022 National Source Tracking Transaction Report - Renewal ML21245A0712021-10-0101 October 2021 OMB 3150-0188, Draft Supporting Statement, NRC Form 531, Request for Taxpayer Identification Number ML21173A0712021-07-19019 July 2021 Final Supporting Statement for 10 CFR Part 31, (3150-0016), 2021 Information Collection Renewal ML21056A4202021-02-25025 February 2021 2021 Chief FOIA Officer Report ML20240A1512020-09-29029 September 2020 OMB 3150-0121, 2020 Final Supporting Statement 10 CFR Part 81, Standard Specifications for the Granting of Patent Licenses ML20160A3922020-06-12012 June 2020 2020 Final Supporting Statement IAEA May 2020 ML20105A0732020-05-19019 May 2020 OMB 3150-0007, Final Supporting Statement for 10 CFR Part 34 Licenses for Radiography and Radiation Safety Requirements for Radiographic Operations ML20126G4642020-05-0505 May 2020 Supporting Statement for Part 55 Exemption Request Online Forms ML20055D9592020-03-0606 March 2020 2019 Chief FOIA Officer Report ML20055D8602020-02-19019 February 2020 2020 Chief FOIA Officer Report ML19233A0652019-10-0707 October 2019 OMB 3150-0164, Final Supporting Statement for NRC Forms 540 and 540A ML19113A0972019-09-30030 September 2019 Requests to Federally Recognized Tribes for Infomation, Draft Support Statement (OMB 3150-XXXX) ML19177A1262019-09-18018 September 2019 OMB 3150-0028 Draft Supporting Statement Form 314 ML19161A2952019-07-0808 July 2019 Draft OMB Supporting Statement for NRC Form 327 ML18121A0121996-05-24024 May 1996 Inventory Report Listing All Jobs Stored in the Archival Facility 2024-06-27
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DRAFT SUPPORTING STATEMENT FORNRC FORM 176 SECURITY ACKNOWLEDGMENT AND TERMINATION STATEMENT (3150-0239)
Extension Description of the Information Collection The reporting requirements associated with the U.S. Nuclear Regulatory Commission (NRC) Form 176, "Security Acknowledgement and Termination Statement," affect the NRC employees, licensees, and contractors who have been granted an NRC access authorization (security clearance). When an applicant requires an NRC access authorization, he/she shall sign the NRC Form 176 prior to access to Restricted Data, Controlled Unclassified Information, and/or Special Nuclear Materials. When the NRC access authorization is no longer required, the employee or contractor acknowledges and accepts his/her continuingsecurity responsibilities, as stated on the NRC Form 176, by signing the form.
The NRC Form 176 requires a minimum amount of personal information (e.g., name, date of termination, last four digits of social security number, and name the person providing the briefing). The form is countersignedby an Office of Administration, Division of Facilities and Security (DFS) employee, or representative of the licensee or contractor who administered the completion of the form by the employee, licensee, or contractor.
There is no recordkeeping requirement for the NRC employee, licensee, or contractor since the completedNRC Form 176 is to be forwarded to NRC headquarters, DFS for retention in the individual's Personnel Security File (PSF). The established retention period of the PSF is destroyed upon notification of death or 5 years after termination of the last access authorization held.
The use of this form affords some assurance that access to classified information, Restricted Data (as defined by Section 11.y. of the Atomic Energy Act of 1954 (42 U.S.C. § 2014)),
Controlled Unclassified Information (as defined by 32 C.F.R. Part 2002 Controlled Unclassified Information), and special nuclear material, as well as the 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 and Practical Utility of the Information Collection Section 4.3 of Executive Order (E.O.) 12958 requires agencies to establish controls over the distribution of classified information to assure that it is distributed only to organizations or individuals eligible for access who also have a need-to-know the information. When an applicant requires an NRC access authorization, he/she shall sign the NRC Form 176 prior to access to Restricted Data, Controlled Unclassified Information, and/or Special Nuclear
Materials. When an individual with access to classified information, Restricted Data, Controlled Unclassified Information and/or special nuclear material is no longer employed in aposition requiring access to such information/material, the NRC will terminate the individuals access authorization in accordance with 10 CFR 25.33 (applicable to licensees) or in accordance with 10 CFR Part 10 and NRC Management Directive (MD) 12.3, NRC Personnel Security Program (applicable to NRC employees and contractors). The NRC Form 176 is an integral part of reminding individuals of their continuing responsibilities after termination of service.
- 2. Agency Use of Information As stated in MD 12.3 (for employees and contractors) and in 10 CFR 25.33 (for licensees), the completed NRC Form 176 is to be forwarded by the employee/licensee/contractor to NRCheadquarters for use by DFS in connection with the security acknowledgment and termination of the respondents employment with the NRC. In addition to providing assurance of NRC compliance with E.O. 12958, the NRC Form 176 is the vehicle used by DFS to apprise the individual of his/her continuing responsibilities for protecting classified information, RestrictedData, and Controlled Unclassified Information that he/she had access to, in the course of performing official duties. The individuals signature on this form indicates their acknowledgment/acceptance of these continuing responsibilities.
Failure to use the NRC Form 176 by the licensee/contractor may result in: (1) failure to properly investigate an applicant for the appropriate access authorization; (2) failure to terminate the NRC access authorization when circumstances dictate and, therefore, unnecessary continued access to classified information, Restricted Data, and/or ControlledUnclassified Information; and (3) the individual not being apprised of, or officially acknowledging (by signature) his/her continuing responsibilities for protecting classified information, Restricted Data, and/or Controlled Unclassified Information.
- 3. Reduction of Burden Through Information Technology The NRC has issued Guidance for Electronic Submissions to the NRC which provides direction for the electronic transmission and submittal of documents to the NRC. Electronic transmission and submittal of documents can be accomplished via the following avenues: the Electronic Information Exchange (EIE) process, which is available from the NRC's Electronic Submittals Web page, by facsimile orby e-mail. It is estimated that approximately less than 30% of the responses are filed electronically.
- 4. Effort to Identify Duplication and Use Similar Information No sources of similar information are available. There is no duplication of requirements.
- 5. Effort to Reduce Small Business Burden
The burden associated with this form is minimal. There is no significant burden on acontractor that is a small business enterprise or entity.
- 6. Consequences to Federal Program or Policy Activities if the Collection is not Conductedor is Conducted Less Frequently The frequency of information collection is limited to circumstances when the respondents NRC service is to be investigated for access authorization and approved access authorization needs to be terminated. In most cases, an individual will need to sign the NRC Form 176 twice. If the information is not collected, the assurance that only appropriately cleared individuals have access to classified information is reduced. Furthermore, it is likely that individuals will be unaware of their continued responsibility to protect classified information. Thus, less frequent collection may endanger the United States common defense and nationalsecurity.
- 7. Circumstances Which Justify Variation from the Office of Management and Budget(OMB) Guidelines There is no variation from OMB Guidelines in the collection of information.
- 8. Consultations outside the NRC Opportunity for public comment on the information collection requirements for this clearance package was published in the Federal Register.
- 9. Payment or Gift to Respondents Not Applicable.
- 10. Confidentiality of the Information Confidential and proprietary information is protected in accordance with NRC regulations at 10 CFR 9.17(a) and 10 CFR 2.390(b). However, no information normally considered confidentialor proprietary is requested.
Personal Information provided on the NRC Form 176 is handled and protected in accordance with NRC directives and provisions of the Privacy Act of 1974, as described inthe Privacy Act Statement on the form.
Information is maintained in a system of records designated as NRC-39 and described in the Federal Register in NRCs Personnel Security Files and Associated Records on December 27, 2019, (84 FR 71568).
- 11. Justification for Sensitive Questions There is no sensitive information requested on the NRC Form 176.
- 12. Estimated Burden and Burden Hour Cost The $288 hourly rate used in the burden estimates is based on the Nuclear Regulatory Commissions fee for hourly rates as noted in 10 CFR 170.20 Average cost per professional staff-hour. For more information on the basis of this rate, see the Revision of Fee Schedules;Fee Recovery for Fiscal Year 2018 (83 FR 29622, June 25, 2018).
An estimated 12 minutes (based on staff experience) is required to complete each NRC Form 176. The NRC staff estimates that 400 responses will be received annually, resultingin a total of annual burden to the public of 80 hours9.259259e-4 days <br />0.0222 hours <br />1.322751e-4 weeks <br />3.044e-5 months <br /> (400 responses x 12 minutes / 60). The estimated annual cost is $23,040 (80 hours9.259259e-4 days <br />0.0222 hours <br />1.322751e-4 weeks <br />3.044e-5 months <br /> x $288 per hour).
NOTE: There is no record keeping requirement for contractors/licensees to maintain acopy of the NRC Form 176.
- 13. Estimate of Other Additional Costs There are no additional costs.
- 14. Estimated Annualized Cost to the Federal Government The staff has developed estimates of cost to the Federal Government related to the conduct ofthis information collection. These estimates are based on staff experiences and subject matterexpertise and include the burden needed to review, analyze, and process the collected information and any relevant operational expenses.
The estimated annual cost to the Federal Government associated with the NRC Form 176 is $23,040. The cost was computed as follows:
Total effort 400 forms X 12 minutes = 4800/60 = 80 hrs. X $288/hr.) =
$23,040.00 Annual record holding (1/4 cubic (cu) foot (ft.) X $212/cu. ft.) = $ 53.00 Total estimated annual cost to Federal government = $23,040 This cost is fully recovered through fee assessment to NRC licensees pursuant to 10 CFRParts 170 and/or 171.
- 15. Reasons for Changes in Burden or Cost The NRC Form 176, Security Acknowledgment and Termination Statement has now added the "Typed or Printed Employee Name" section to the NRC Form 176C page. This page is used when departing people are debriefed.
NRC cannot read signatures and therefore the form was modified to include print name. There is no change in the burden required to complete the form.
The cost has increased due to a change in the fee rate from $275/hr. to
$288/hr.
- 16. Publications for Statistical Use There is no application of statistics in the information collections related to NRC Form 176 and no publication of the information.
- 17. Reason for Not Displaying the Expiration Date The expiration date is displayed on the form.
- 18. Exceptions to the Certification Statement Not Applicable.