ML22353A096

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NRC Form 974, Privacy Act Complaints, Concerns or Questions Form
ML22353A096
Person / Time
Issue date: 12/19/2022
From:
NRC/OCIO, NRC/OGC
To:
Shared Package
ML22355A199 List:
References
Download: ML22353A096 (1)


Text

NRC FORM 974 U.S. NUCLEAR REGULATORY COMMISSION APPROVED BY OMB: NO. 3150-XXXX EXPIRES: (MM/DD/YYYY)

(MM-DD-YYYY) Estimated burden per response to comply with this mandatory information collection request: XX minutes. This submittal is used by NRC to XXXXXXXXXXXXXXXXXXXXX. Send comments regarding burden estimate to the FOIA, Library, and Information Collections Branch (T-6 A10M), U.S. Nuclear PRIVACY ACT COMPLAINTS, Regulatory Commission, Washington, DC 20555-0001, or by email to Infocollects.Resource@nrc.gov, and the OMB reviewer at: OMB Office of Information and Regulatory Affairs, (3150-XXXX), Attn: Desk CONCERNS OR QUESTIONS FORM Officer for the Nuclear Regulatory Commission, 725 17th Street NW, Washington, DC 20503; email:

oira_submission@omb.eop.gov. The NRC 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.

Name (Last, First, and Middle Initial) Telephone Number

Email Address

Provide summary of complaint or a written description of the specific circumstances.

Provide a summary of the actions you or the NRC has taken to resolve this complaint.

Provide the preferred method of contact regarding your complaint (i.e., mailing address, email address, phone number)

Note: NRC will send acknowledgement within 10 business days of receipt of your complaint.

Signature and Date

NRC Form 974 (MM-DD-YYYY)