ML23089A290

NRC Form 974 Privacy Act Complaints Form

ML23089A290
Person / Time
Issue date:	06/28/2023
From:	NRC/OCIO
To:
Shared Package
ML23089A312	List: ML23081A464 ML23089A290
References
Download: ML23089A290 (1)

Text

NRC FORM 974 (MM-DD-YYYY)

U.S. NUCLEAR REGULATORY COMMISSION PRIVACY ACT COMPLAINTS, CONCERNS OR QUESTIONS FORM EXPIRES: (MM/DD/YYYY)

APPROVED BY OMB: NO. 3150-XXXX Estimated burden per response to comply with this voluntary information collection request: 15 minutes. This information is required by the National Institute of Science and Technology (NIST) Special Publication 800-53 Revision 5, Security and Privacy Controls for Information Systems and Organizations. The Nuclear Regulatory Commission (NRC) is providing an electronic mechanism for the public to voluntarily register complaints, concerns or questions regarding data collection practices at the NRC. Send comments regarding burden estimate to the FOIA, Library, and Information Collections Branch (T-6 A10M),

U.S.

Nuclear 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 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)

SIGN Submit by Email