Latest revision as of 18:19, 5 January 2025

Text

NRC-2018-000043 - Resp 1 - Final
	ML18169A071
Person / Time
Issue date:	06/14/2018
From:	Stephanie Blaney; NRC/OCIO
To:	Tarver J; - No Known Affiliation
References
	FOIA, NRC-2018-000043
	Download: ML18169A071 (22)
	v • d • e

NRC FORM 464 Part I U.S. NUCLEAR REGULATORY COMMISSION NRC RESPONSE NUMBER (03-2018)

+~~..,. J11oc.,'-t>o I NRC 2018 00004311 1

I 11 RESPONSE TO FREEDOM OF

'I, INFORMATION ACT (FOIA)_REQUEST RESPONSE D 0

INTERIM FINAL

... '%-.,......... *rf TYPE REQUESTER:

DATE:

!Julian Tarver 11 06/14/2018 I

DESCRIPTION OF REQUESTED RECORDS:

Index of all NRC forms showing form # and title of each form PART I. -- INFORMATION RELEASED D

The NRC has made some, or all, of the requested records publicly available through one or more of the following means:

(1) https://www.nrc.gov; (2) public ADAMS, https://www.nrc.gov/reading-rm/adams.html; (3) microfiche available in the NRC Public Document Room; or FOIA Online, https://foiaonline.regulations.gov/foia/action/public/home.

0 Agency records subject to the request are enclosed.

D Records subject to the request that contain information originated by or of interest to another Federal agency have been referred to that agency (See Part I.D -- Comments) for a disclosure determination and direct response to you.

D We are continuing to process your request.

0 See Part I.D -- Comments.

PART I.A -- FEES D You will be billed by NRC for the amount indicated.

0 Since the minimum fee threshold was not AMOUNT met, you will not be charged fees.

I

$0.00 I D You will receive a refund for the amount indicated.

D Due to our delayed response, you will not D Fees waived.

be charged fees.

PART 1.8 -- INFORMATION NOT LOCATED OR WITHHELD FROM DISCLOSURE D

We did not locate any agency records responsive to your request. Note: Agencies may treat three discrete categories of law enforcement and national security records as not subject to the FOIA ("exclusions"). See 5 U.S.C. 552(c). This is a standard notification given to all requesters; it should not be taken to mean that any excluded records do, or do not, exist.

D We have withheld certain information pursuant to the FOIA exemptions described, and for the reasons stated, in Part II.

D Because this is an interim response to your request, you may not appeal at this time. We will notify you of your right to appeal any of the responses we have issued in response to your request when we issue our final determination.

D You may appeal this final determination within 90 calendar days of the date of this response. If you submit an appeal by mail, address it to the FOIA Officer, at U.S. Nuclear Regulatory Commission, Mail Stop T-2 F43, Washington, D.C. 20555-0001. You may submit an appeal by e-mail to FOIA.resource@nrc.gov. You may fax an appeal to (301) 415-5130. Or you may submit an appeal through FOIA Online, https://foiaonline.regulations.gov/foia/action/public/home. Please be sure to include on your submission that it is a "FOIA Appeal."

PART I.C -- REFERENCES AND POINTS OF CONTACT You have the right to seek assistance from the NRC's FOIA Public Liaison by submitting your inquiry at https://www.nrc.gov/reading-rm/

foia/contact-foia.html, or by calling the FOIA Public Liaison at (301) 415-1276.

If we have denied your request, you have the right to seek dispute resolution services from the N RC's Public Liaison or the Office of Government Information Services (OGIS). To seek dispute resolution services from OGIS, you may e-mail OGIS at ogis@nara.gov, send a fax to (202) 741-5789, or send a letter to: Office of Government Information Services, National Archives and Records Administration, 8601 Adelphi Road, College Park, MD 20740-6001. For additional information about OGIS, please visit the OGIS website at https://www.archives.gov/ogis.

NRC FORM 464 Part I U.S. NUCLEAR REGULATORY COMMISSION NRC RESPONSE NUMBER (03-2018)

I NRC 2018 00004311 1

RESPONSE TO FREEDOM OF

INFORMATION ACT (FOIA) REQUEST RE~~~SE D INTERIM I./ I FINAL PART I.D -- COMMENTS Please note:

The NRG is providing the requested records to you in their entirety.

Since you stated that you do not have access to a computer, we are providing courtesy copies.

Signature - Freedom of Information Act Officer or Designee Stephanie A. Blaney

\\ Digitally signed by Stephanie A. Blaney

./* Gate: 2018.06.14 07:55:56 -04'00' I

3 Notice to Employees (is a map)

'-------'-~----

3 A Notice to Employees (Spanish) 4 Cumulative Occupational D_ose History

---~---------------

5 Occupational Dose Record for a Monitoring Period 6

SECY Paper Distribution 7

Application for NRC Export or Import License, Amendment, Renewal, or Consent Request(s) 8 _______________ Incoming & Signature_ Tab (Index Card) 8A Concurrence & Signature Tab (Salmon Index Cover Sheet)

______ Background & Signature Tab _(Green Index Cover Sheet)

_@_C Correspondence Cover Sheet (Blue Index Cover Sheet)

I 14 Report of Unsafe or Unhealthful Working Conditions

@=Ha_____

Employee Locator Notification - Headquarters 15 R1 Employee Locator Notification - R1 15 R2 Employ~e_e_L_o_c_a __

to_r_N_o_t_ifi_ca_t_io_n_-_R_I_I ------------------------

15_~--

Employee Locator Notification - RIii

~-------------

15 R4 Employee Locator Notification - RIV

~------------- Request for Printing and Copying Services ----------------------------

21 NRC Transmittal Letter of Documents to Subject Facility 22 Charge out Record (Pink Card) 23 ____________ Publica-tions Branch Copyrighted Materials Reproduction Release Form 30 Reg~est for ~~ministrative Services 30 (OGC)

Request for Administrative Services 30C (Rill)

Request for Administrative Services (Rill) 33-------

Document Distribution and Control.. _,_____,_ __ _

i35A Records Transfer 36 Certification of Search 36A

___________ Compilation Certification of Search_

37 Notice of Eligibility for Permanent Transfer to NARA 38

___ _B~cor_ds Management (RM) Certification Form _

39 Secured Area Visitor's Log 41A Acknowledgmer:!t Cards pt. A 47 Request for Registered, Certified, and Return Receipt Mailing 64 NRC 64, 6~A. 648 Travel Voucher 70A Request for Name Check 73 Law Library Charge Card

76 Library Services Request (Print Only) 80 Temporary Badge Request/Receipt Due to Lost or Forgotten Badge 89 Contractor, Other Government Agency Employee, or Foreign Assignee Badge Request 90 Classified Courier Card Application and Approval 102 Memorandum to RRDB/ADM 104 Blanket Purchase Agreement 114 Career Opportunity Announcement 115 Vacancy Application Status Notice 119 Custodial Receipt for Sensitive and Non-Sensitive Personal Property 119A ADP Inventory (RIV) 121 Request for NRG-Sponsored Training 122 Security Plan Foreign Nationals Participating in NRG-Sponsored Training 123 Request for Accommodation 125 Work Request 126 Classified Document Receipt 133A Obligation, Expenditure and Cost Record 134 Filing Equipment Request Analysis (Filing Equipment - file cabinets, shelving, and book cases) 135 Security Incident Report 136 Security Termination Statement 137 Request for Personnel Security Files and Associated Records 138 Property Data Base Maintenance Record -- (Additions) 138A Property Data Base* Maintenance Record -- (Additions) - Discontinued 140A Security Survey Report 142 Urgent (Red Stickers) 3 X 5 145 Request and Authorization for Irregular or Occasional Overtime or Compensatory Time 147 Contract Payment Record I

148 Voucher for Professional Services 150A Data File Exterior Label 1508 Computer Reel Tape Label 160 Request for Forms Management Services i

161 Forms Status Notice 162 Request for Review of Form for Privacy Act Statement i

163 Request for Review of Form 164 Request for Form Data Retention i

165 Discontinue 0MB Control Number 167 Purchase Order Summary l

(~~ ';

171 Duplication Request 172 Library Borrower s Cards 172A Library Borrower s Cards pt A 1728 Library Borrower s Cards pt B I

I 173 Standard Order For Doe Work (SOEW) 176

- Security Acknowledgment Special Nuclear Material Access Authorization Acknowledgment 178 Candidate Evaluation, Certification and Selection Record 182 Activity Report on Security Alarm Systems 183 Report of Security Incident 187 Contract Security and/or Classification Requirements 188 Drug Testing Criteria Documnet 188A Restricted Data Envelopes pt A 1888 Restricted Data Envelopes pt B 189 DOE Laboratory Project and Cost Propos~I for NRC Work, Part 1, 2, 3 & 4 190D (Black and White) Investigation Information Coversheet-(Green) Black and White 190D (Color Image)

Investigation Information Coversheet (Green) Color Image 190E (Black and White) Investigation Information Coversheet Labels (Green) Black and White 190E (Color Image)

Investigation Information Coversheet Labels (Green) Color Image I

/

190F (Black and White) NRC 190F, Investigation Information Coversheet CD Labels (Black and White) 190F (Color Image)

NRC 190F, Investigation Information Coversheet CD Labels (Green) Color Image i

197C Technical Assignment Control Office of NMSS 199 Trial Period Appraisal 203 Agreement Covering Discoveries, Inventions, and Improvements 205 Visitor Register 205A Visitor Register - Regional Offices 206 Control Card 210 Acknowledgment Transmittal 211 Request for Official Change of Station Order Information in Accordance with NRC Travel Regulations*

212 Qualifications Investigation Professional, Technical, and Administrative Positions 217 Lost Badge Report 217A Lost Temporary Badge Report 219 Notice of Unsafe or Unhealthful Workplace Conditions i

221 Bomb Threat 225 File Summary Sheet 229 Imprest Fund Balance Verification 231 NRC Data Center Access Request Form

1232 FOIA Estimate Request Form 233 FOIA Processing Sheet 235 Chargeout Card 236 Personnel Security Clearance I

237 Request for Access Authorization 238 NRC Data Center Access Request Form 238A Employee Move Request (Telecommunications) 241 Report of Proposed Activities in Non-Agreement States, Areas of Exclusive Federal Jurisdiction, or 0:

244 Registration Certificate -- Use of Depleted Uranium under General License 250 Export License 250A Export License Conditions 250P Export License 253 Messenger/Courier Receipt 260 Import License i

264 Employee Application For Reimbursement of Expenses Incurred Upon Sale or Purchase (or both) of 266 Request for Extension of Storage Beyond 60 Days 267 Request for Movement of Household Goods 270 Separation Clearance

273 Indemnity Agreement Record 277 Request for Visit I

279 Official Travel Authorization 279A

- - Do not Upload to SP*** Official Travel Authorization Change of Station (MS Excel file) -

280 Request for Extension of Change of Station Orders Beyond 1 Year 286 Record of Disclosure (Personnel Security Files - NRC-39) 289 Request for Financial Plan Changes 289A Request for Financial Plan Changes 290 Project Specifications 291 Voucher Log i

292 Voucher Transmittal For Review and Approval Prior to Payment 292A Invoice Envelope I

294 Transfer of Cash Among Principal, Alternate, and Subcashiers 294A Transfer of Cash Among Principal and Alternate Cashiers 2948 Transfer of Cash Among Principal and Alternate Cashiers 299 Performance Evaluation *(Carriers of Household) 302 Cress Word Processing Service Word Processing Service Work Order 303 NRC 303 & 303A Request for Analysis and Chain of Custody Sample Record

304 NRC 304 & 304A Sample Record Sheet and Continuation 304A Sample Records Sheet (Continuation) 305 Request for Technical Assistance 306 DO NOT LOAD NRC 306 & 306A Files Maintenance and Di~position Plan and Continu~tion 306A DO NOT LOAD File Maintenance and Disposition Plan and Continuation 310 CERTIFICATE OF PROFICIENCY IN TYPING AND/OR SHORTHAND, 311 Quality Assurance Program Approval for Radioactive Material Packages

313, Application For Material License 313A(AMP)

Authorized Medical Physicist Training and Experience and Preceptor Attestation 313A(ANP)

Authorized Nuclear Pharmacist Training and Experience and Preceptor Attestation 313A(AUD)

Authorized User Training and Experience and Preceptor Attestation (Diagnostic) 313A(AUS)

Authorized User Training and Experience and Preceptor Attestation (Nuclear Medicine Therapy) 313A(AUT)

Authorized Medical Physicist Training and Experience and Preceptor Attestation (Sealed Source The 313A(RSO)

Authorized Medical Physicist Training and Experience and Preceptor Attestation (Radiation Safe.ty Of 314 Certificate of Disposition of Materials 316 Telephone Request for Information (Request for Documents/Information from or about Documents). ',

317 Annual Report of Records Holding and Disposition 317A Records Inventory Worksheet 3178 Table of Equivalents For Computation of Record Volume 321 Individual Development Plan 323A Worksheet For Benchmark Correlation of GG 1-15 Positions 326' Correspondence Control 327 Special Nuclear Material (SNM) and Source Material (SM), Physical Inventory Summary Report 328 Request For Restoration of Annual Leave Based on Exigency of Public Business

i 331 Concurrence of Proposed Record Disposition Authority 335.

Bibliographic Data Sheet.(lnstruction Page Only)

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335 Bibliographic Data Sheet (Sheet only) 338 Request For Official Time For Union Representational Function i

340 Vital Business Information Inventory 340A Legal and Financial Rights Records ldenfication and Implementation Data 346 Cash Receipt 351 SES Performance Planning and Appraisal 351M SES Performance Planning and Appraisal 354 Data Report on Spouse 355 Report of Records/ Nonrecords Disposal 356 U.S. Nuclear Regulatory Commission Senior Executive Service (SES) Candidate Development Progi

358 Request For Micrographics Service 358A Request For Micrographics Service - Filming J

359 Log of Monies Received 361 Reactor Plant Event Notification Worksheet I

361A Fuel Cycle and Materials Event Notification Worksheet 361C Gaseous Diffusion Plant Event Notification Worksheet i

363 Employee Suggestion 364 Evaluation of Suggestion 366 Licensee Event Report (LER) 366A Licensee Event Report (LER) Text Continuation 3668 Licensee Event Report (LER) Text Continuation 367 DOE Source Selection Justification 368 Training Request and Authorization 370 Transmittal of Invoice For Goods/Services Rendered i

372 Certification of Completion of The Senior Executive Service (SES) Probationary Period 374 Materials License 374A Materials License Supplemental Sheet 379 Report Processing 380 Computer Facility Access/Change Request 382 Annual Distribution List Survey 386 Telecopier Transmittal (Headquarters) 386A Telecopier Transmittal (A) International Travel - Nuclear Energy Agence (NEA)

I 3868 Telecopier Transmittal (A) International Travel - OECD/NEA 386 (RIii)

Telefax Transmittal (Region Ill)

I I

387 (Rill)

Telefax Transmittal with Expanded Message Section 388 Incoming Facsimile Control Log - Discontinued I

389 Outgoing Facsimile/Data Control Log - Discontinued 390 Release to Publish Unclassified NRC Staff Speeches, Papers, and Journal Articles* -

390A Release to Publish Unclassified NRC Contractor Speeches, Papers, and Journal Articles 3Q4 Internal Reports Clearance 395 Report of Property For Survey 396 Certification of Medical Examination by Facility Licensee 396A Certification of Medical Examination Transmittal and Report 397 Licensee/application/renewal Log I

398 Personnel Qualifications Statement -- Licensee 399 Invoice

400 Request For Procurement Action (RFPA) 400A Justification to Enter Into a Consultant Contract I

4008 Schedule A Competitive Procurement Milestone Schedule 403 Management By Objectives - Milestone Plan 404 Evidence Property Custody Document Office of Investigations 405 File Tran~fer Record 405F List ALL Owners, Officers, Directors, and Executive Personnel (OODEP's) 406 Request For Review of 0MB Information Collection Requirements.

407 Paperwork Reduction Act Violation Reporting Form 408.

Assessment of Proposed Information Collection 412 Non-SES Performance Appraisal System Summary Rating and Performance Plan 2011 412A Non-SES Performance Appraisal System Summary Rating and Performance Plan pt A 2010 412X Non-SES Two-Level Performance Appraisal Pilot Program Performance Plan 414

Routing Slip, EDO - Discontinued 414A Routing Slip, EDO (A) - Discontinued 417 Official Record of Bid/Proposal Receipt 420 Request For Premium Cost Mail Service 426 Release to Publish Unclassified NRC Staff Publications 426A Release to Publish Unclassified NRC Contractor, Grant, and International Agreement Reports, and C 430 Request For Translation of Unclassified Document.*

431 Evaluation of Unclassified Document 436 Report of Work-Related Injuries And Illnesses 438 NRC Translations Service Work Order 441 U. S. Nuclear Regulatory Commission Security Agreement i

441A Appendage to the U. S. Nuclear Regulatory Commission Security Agreement 445 Request For Approval of Official Foreign Travel I

446 Certification of Microform Quality and Content-Discontinued 448 Request For Appointment of a Consultant, Expert, or Member 449 Statement of Consultant, Expert, or Member 450 General Assignment 452 Checklist for Offsite Meetings/Conferences 453 BPA Order Form 454 BPA Past Performance Questionnaire 455 Survey for Meetings/Conferences Support Services 456 Survey for General Office Supplies 457 Request For Temporary.Quarters Allowance

458 Request For Extension of Temporary Quarters 460 Request For Graphics.Services 461 (Black and White)

Safeguards Information Coversheet (SGI) (Lavender Borders) Black and White 461 (Color Image)

Safeguards Information Coversheet (SGI) (Lavender Borders) Color Image 461A (Black & White)

Safeguards Information Coversheet (SGI) CD Labels (Lavender Borders) Black and White 461A (Color Image)

Safeguards Information Coversheet (SGI) CD Labels (Lavender Borders) Color Image 463 FOIA Request Submittal 464 Part I Response to Freedom of Information Act (FOIA) Request 464 Part I (OIG)

Response to Freedom of Information Act (FOIA) Request 464 Part II Response to Freedom of Information Act, (FOIA) Request 1

464 Part II (OIG)

Response to Freedom of Information Act (FOIA) Request 465 Security Termination Debriefing Summary - Discontinued 466 Property Pass 467 Visitor Personal Property.Pass 468 Request And Authorization for Expenditure of Official Representation Funds 478 Supplemental Payroll Data - Discontinue i

481 Employee's Course Evaluation Follow-Up 483

Registration Certificate -.In Vitro Testing With Byproduct Material Under General License i

484 Detection Monitoring Data Report (External Form) 487 lnteragency Report Evaluation Factors - Discontinued 490 Supply Request from GSA Global 491 Recurring. Internal Report

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492 Quotation for Small Purchases 493 Property Transfer Request 494 U. S. Nuclear Regulatory Commission Headquarters Motor Pool Fleet Inspection and Vehicle Trip Su 496 Report of Staff Resources for Processing FOIA Requests 496A Referral of Records Related to FOIA Request 497 I

Request For Additional Records 498 Request For Revalidation of NRC Info. Collection Requirements 499 Request for Records (File Center) l 500 NRC Record Transfer Verification 501 NRC Archival Facility Work Assignment Sheet.

I 501A NRC Archival Facility Work Assignment Sheet Miscellaneous Services 504 Donation of Annual Leave 505 White Flint Complex Application for Parking 505 (RII)

Region II Application for Parking f

505A Application for Handicap Parking 506 Harmful Radio Interference Report 507 Freedom of Information I Privacy Act Record Request Form 509 Statement of Estimated Fees for Freedome of Information Act (FOIA) Request 509A Statement of Estimated Fees For Freedom of Information Act (FOIA) Appendix A Records Already A, 510 Personal Records Checklist 511 FOIA Memorandum 512 Delegation of Discretionary.Release Authority Memorandum-FOIA 513 Certification of Copy of Official Record 514 Restoration of Donated Leave l

515 Relocation of Employee 516 Driving Assignment Log 518 Audit Tracking Report 519 Transfer of Official NRC Records to an Agreement State and (Continuation) 519A Transfer of Official NRC Records to an Agreement State and (Continuation) pt. A 520 Certification of Staff Review and Office Issuance for an NRC Management Directive i

521 Request for Publication or Elimination of an NRC Management Directive 522 Approval for Issuance of a Directive or Handbook I

523 Request for Extension - NRC Management Directive 524 Transfer of Official NRC Records to Other Federal Agencies and (Continuation) 525 Request For And Authorization of Release of Dosimetry Records 526 Certification of Small Entity Status for Purposes of Annual Fees Imposed under 10 CFR Part 171 (Eft.

527A Thank You Postcard 528 Question/Response 530 Request for Microcomputer System 531 Request for Taxpayer Identification Number I

532 Acknowledgement - Receipt of Correspondence 532A Acknowledgement Postcard 532A (RIii)

Post Card -- Licensee Application Letter 5328 Acknowledgement Postcard 532 (RI)

Post Card -- Licensee Application Letter 532 (RII)

Post Card -- Licensee Application Letter

532 (RIV)

Post Card -- Licensee Application Letter 536 Operator Licensing Examination Data 537 Authorization to Receive an NRC Dosimeter

!538 D1scontmued - NRC Headquarters Dosimeter Log

539 Commercial Nuclear Power Plant Licensee Questionnaire 540 Uniform Low-Level Radioactive Waste Manifest Shipping Paper 540A Uniform Low-Level Radioactive Waste Manifest Shipping Paper (Continuation) 541 Low-level Waste Manifest Container and Waste Description and (Continuation) 541A Low-level Waste Manifest Container and Waste Description and (Continuation) 542 Low-level Waste Manifest Index and Regional Compact Tabulation and (Continuation) i 542A Low-level Waste Manifest Index and Regional Compact Tabulation and (Continuation) pt. A 545 Transfer of State Government Records to the NRC 545A Transfer of State Government Records to the NRC pt. A 546 NRC Transit Subsidy Benefits Program Application I

546A NRC Transit Subsidy Benefits Program Application Notification of Temporary Change 546B (RII)

NRC Transit Subsidy Benefits Program Application 546C (RIH)

Region 111 Application for Public Transit Subsidy Benefits 548 Sample Summary Score Sheet - Discontinued I

549 Public Meeting Announcement Data 550 Micrographic Services.Survey I

552 Monthly Letter Status Report Review 552A

Status Report Review 553 NRC/DOE Work Orders - Closeout Checklist 554 Independent Government Cost Estimate (IGCE) 554A Independent Government Cost Estimate (IGCE) for DOE Laboratory Agreements 554B Independent Government Cost Estimate (IGCE) for lnteragency Agreements I

555 Summary of Negotiations 555A Summary of Negotiations lnteragency agreements I

556 Fiscal Year Advance Procurement Plan DOE Laboratory Project 556A Fiscal Year Advance Procurement Plan* lnteragency Agreement I

557 NRC\\DOE Work Order Pre-award Checklist 558 *

Summary of Proposal Evaluation i

558A Summary of Proposal Evaluation lnteragency Agreement 559 Project Closeout Certification 559A NRC/lnteragency Project Closeout 560 Property Certification I

f 561 Supervisory Appraisal of Demonstration 562

Mail List Maintenance 563 Applicant Self-Assessment 564 Identification of Specialties for Engineering and Scientific Positions - Discontinue

565 Event Report 566 Medical Misadministration Report 567 Request for a Sealed Source or Device Evaluation 568 Office Information Technology Application Requirements - Discontinue 570 Access Authorization Acknowledgment 572 NRC Bankcard Log 574 OCIO Customer Support 577 License Fee Requirements 578 Small Entity Status Denial 579 Reply to Incoming Correspondence 580 Approval for Adding, Modifying, or Deleting Program Codes 582 0MB Clearance Record 587 Request for Court Reporting Service 588.

License for lndependen_t Storage of Spent Nuclear Fuel and High Level Waste and (Continuation) 588A License for Independent Storage of Spent Nuclear Fuel and High Level Waste and (Continuation) pt.

589 Evidence Property Custody Document 590 Application/Permit for Use of TWFN Auditorium 591 Part 1 Safety and Compliance Inspection 591 Part 2 Safety and Compliance Inspection 591M Safety Inspection and Compliance, Part 1, Part 2 and Part 3 591S Safety Inspection Report and Compliance Inspection, Part 1, Part 2 and Part 3 592 Performance of NRC - Allegation Program I

593 (RII)

Quarterly Exposure History 595 Incoming Express Accountable Mail Delivery

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596 Daily Garage Log 597 Gainsharing Award Nomination 598 Competitive Negotiated Procurement Milestone Schedule 599 Noncompetitive or 8(a) Set-aside Procurement Milestone Schedule i

600 Employee Claim for Loss or Damage to. Personal Property 601 Contract Administration Summary 602 Hours of Duty Schedule-Discontinued 603 Secure Telephone Check Sheet*

I 604 Record of Keys Issued 605 Record of Tii:ne of Arrival and Departure Contract Security Officer Duty Register 606 Record of Time of Arrival and Departure from Breaks Relief Security Officer Duty Register 607 Officers Operations Log

1608 Firearms and Security Officer Equipment Control Register 609 _____

Routine _l!!spection of NRC Headquarters Security Officer Posts Chec_k_Li __ st ____________ _

610 Record of Property Found and Attempt to Contact Owner 2 lL _ _ _ _

Found Property (Self-mailer C_a_rd~) _____________________________ _

612-NRC Badge Inventory Checklist

~--~----------------------------

613 Allegation Program Identity Protection Policy 616 Discontinued---=--N*o-t-if-ic-a-ti-on~o--f -E-le-c-tr-on_i_c-ln-f~o~rm_a_t-io_n_S_y_s-te_m_D_e_s-ig_n_o_r_M_od-i-fic_a_t-io_n __

1-617__

_ ____ Request for Mailing Lis_t Upda_~e Information f~r the_~nnu~Regulat~ry Information Conference (RIC) 618 Certificate of Compliance for Radioactive Materials Packages and (Continuation) 1618A Certificate of Compliance for Radioactive Materials Packages and (Continuation) pt A 620 Assessment and Certification of Proposed Information Collection 621 Empl~~-e Reque~t to ~articip~te in the Telework Program 622 Evaluation of Employee Request to Participate in the Telework Program 624 l:J.:_§_:J\\Juc!ear Regulatory_~ommission Telework Program Participation Agreement

-*-----*~--*

625 Telework Program Employee Self-Certification Safety Checklist 628 Financial EDI Authorization 629 Authorization for Payment by Credit Card 630 NRC NUDOCS Registration 631 CISSCO Program Task Assignment Control (TAC) 632 CISSCO Pro9.rar:n Wor!s__Estimate 634 CISSCO Program Independent Government Cost Estimate 635

___ g!§,_SC_Q__Program lndepen_~ent Final Deliverable 636 CISSCO Program Independent Certification of Contractor Work 637 NRC Electronic Information System Records Scheduling Survey-Discontinue

~---*-*--*~----------*-------------*

638 Industrial/Academic/Research Inspection Field Notes 639 0MB Ap_eroval Section Updat~ Checklist 640 Mail Stop Listing 641 (RII)

Property Account Change -

642 Training and Experience - Authorized Use*r or Radiation Safety Officer 643 Preceptor Statement I

644 RIC Survey 645 Instant Cash Award (Discontinued??) "'

646 Formal Discrimination Complaint 648 NRC Accountability Record

651 Certificate of Compliance for Spent Fuel Storage Casks 652 Record of Standards Committee Assignment 653 Transfers of Industrial Devices Report 654 SDO Participant Training Record i

655 EEO Counselor's Report 656 Exemption 7(a) Certification 659 NRC Public Meeting Feedback 659A Runion Publica de Retroalinetacion 660 NRC Incident Response Log 661 IMD Acquisition Summary For All Procurement Actions 662 Award of lnteragency Agreement 663 Discontinued - Justification to Place Work With Another Federal Agency....

664 General License Registration 665 ADAMS Document Submission 665P Adams Document Submission 667 Spending Plan and Servicing Agency Project And Cost Proposal for NRC Work 668 Non-Disclosure Agreement 669 Personal Financial Statement 670 Information Required For Making an Insignificant Burden Determination 671 Request for Approval Under the "Generic Clearance for the Collection of Qualitative Feedback on Ag:

671A Request for Approval Under the Requests to Agreement States for Information, 3150-0029 or Non-A!

672 Declaration of Pregnant Worker I

672 (RIV)

Declared Pregnant Worker 673 (RIV)

Request for: Dosimeter (Region IV)

I 675 NRC Business Cards -HQ Black & White - Seal 675 NRC Business Cards - Black & White - Seal-RI 675 NRC Business Cards - Black & White - Seal-RII 675 NRC Business Cards - Black & White - Seal-RII 675 NRC Business Cards - Black & White -Seal-RIii 675 NRC Business Cards - Black & White - Seal-RI 11 i

675 NRC Business Cards - Black & White - Seal-RIV 675 NRC Business Cards - Black & White - Seal-RIV 675 NRC Business Cards-Black & White - Seal-TIC 675 NRC Business Cards - Black & White - Seal-TIC 676 NRC Bus Cards - Branding Logo - FSME 676 NRC Bus Cards - Branding Logo - FSME j

676 NRC Bus Cards - Eagle Logo - FSME 676 NRC Bus Cards - Eagle Logo - FSME 676 NRC Bus Cards - Branding Logo - RS 676 NRC Bus Cards - Branding Logo.- HQ 676

NRC Bus Cards - Branding Logo - HQ 676 NRC Bus Cards - Eagle Logo - RS i

676 NRC Bus Cards - Eagle Logo - HQ 676 NRC Bus Cards -* Eagle Logo - HQ 1

j 676 NRC Bus Cards - Branding Logo - R1 676

NRC'Bus Cards - Branding Logo - R1 676 NRC Bus Cards - Eagle Logo - R1 676 NRC Bus Cards - Branding Logo - R2 676 NRC Bus Cards - Eagle Logo - R2 676

NRC Bus Cards - Branding Logo - R3 676 NRC Bus Cards - Eagle Logo - R3 676 NRC Bus Cards - Branding Logo - R4 676 NRC Bus Cards - Eagle Logo - R4 676 NRC Bus Cards - Branding Logo - TTC

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676 NRC Bus Cards - Eagle Logo - TTC.

680 Differing Professional Opinion i

681 NRC Fitness Center Membership Application 681a NRC Fitness Center Informed Consent 682 Regional and Remote Employee Fitness Services Registration and Reimbursement Form 683 Regi~nal and Remote Employee Fitness Services Registration and Reimbursement Form for Special:

689 Physical Fitness Schedule 690 Differing Professional Opinion - Appeal i

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691 U.S. Nuclear Regulatory Commission Student Loan Repayment Program 692.

Review Coordination 1

693 NRR International Travel Checklist 694 NRC Foreign Trip Report i

695 Request for Name Search-Discontinue 696 Time and Labo! Designation 697 Time and Labor Unit Change 699 Conversation Record 707 Hours of Work Request 707A HOURS OF WORK REQUEST -- NTEU/NRC PILOT WORK SCHEDULE PROGRAM l

w,_R_ll_.l) ______

H_o_u_r_s_o_f _W_o_r_k_R_e_,q __

ue_s_t _________________________

709 Annual Evaluation/Extension of Full Time Telework Agreement 710 Credit Hour Plan 711 Rotational Assignment Application 722 Request For Private Sector Temporary Services 723 Travel Payment Agreement 726A Denial of Reasonable Accommodation Request 726 Confirmation of Request for Reasonable Accommodation 7268 Reasonable Accommodation Information Reporting Form 729 Expanded Compressed Work Schedule (E-CWS) 730 Exit Interview Survey 731 Mail Stop Locator 732 Informal Awards Memorandum 734

_ Application for the Child Care Subsidy Program 735 NRC Leadership Potential Program Application 736 NRC Name Ta~s 737 NRC Name Tents 739 Travel Planner a_nd l~nerary -- Region Ill 740 Request for Web Graphics 740M Concise Note 741 Nuclear Materials Transaction Report 742 Materials Balance Report 742C Physical Inventory Listing, NMSS 746 NRC Name Tags*

747 Equipment Data Sheet 747A Equipment Data Sheet (7 or more items) 7478 Government Furnished Property Data Sheet 748

_National Source TrackJngTransaction_Report (Long Form) 748A National Source Tracking Transaction Report. Report Source Inventory 7488 National Source T_racking Transaction Report. Transfer Source 748C National Source Tracking Transaction Report. Receive Source 7480 National_ Source Tracking Transaction Report. Dispose Source 748E National Source Tracking Transaction Report. Manufacture Source 748F

~ational Source Tracki~g Transaction Report. Import Source 748G National Source Tracking Transaction Report. Export Source 748H National Source Tracking Transaction Report. Dissemble Source

749 Manual License Verification Report 750 Applicant Background Survey I

751 Time And Attendance (T&A) Control 753 Conference Planning Checklist 754 Armed Security Personnel Firearms Background Check-on hold till omb approves-public form 757 Non-Concurrence Process 758 Cost Activity Code R~quest Form 759 Staff File Input 7590 (RIV)

RIV Personnel Change Notice 760 Non-Radiological Hazards Data Sheet 761 (Black and White)

Confidential Allegation Material Coversheet (Red) Black & White 761 (Color Image)

Confidential Allegation Material Coversheet (Red) Color Image 761A (Black and White) Confidential Allegation Material Labels (Red) Black & White 761A (Color Image)

Confidential Allegation Material Labels (Red) Color Image 762 (Black and White) Sensitive Allegation Material Coversheet (Blue) Black & White 762 (Color Image)

Sensitive Allegation Material Coversheet (Blue) Color Image 762A (Black and White) Sensitive Allegation Material Labels (Blue) Black & White 762A (Color Image)

Sensitive Allegation Material Labels (Blue) Color Image 769 Assignment Agreement 770 Application for Graduate Fellowship Program 771ES E-Safe Record Transmittal 772 Safeguards Lan & Electronic Safe (SLES) New User Account Request l

772A Position Action and Evaluation 7728 Position Action And Evaluation Grades--16-18, SES And SR I

773 Request for Removal of SGI Documents from E-Safe 774 Request for Addition of File/Folder to E-Safe File Plan 776 Property Custodian Delegation 777 eTravel Access Request I

778 eTravel Access Removal 779 Site AccessRequest 780 Government Travel Card Individual Liability 780A -

Cltibank Government Travel Card-Credit Worthiness Evaluation Authorized 781 SBCR Compliance Review 782 Complaint Fo~m i

786 Routing and Transmittal Slip 786A Commissioner Ostendorff Routing and Transmittal Slip

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787 Freedom of Information Act - User Survey 790

Classification Record t

800 NRC Health Center Appointment Instructions for Physicals for Headquarters 800A Appointment Instructions for Physicals for Regional Employees 801 NRC Health Center Employee Health Record 802 NRC Health. Center Physical Examination*- Hearing History 803 NRC Health Center Consent for Release of Medical Information 804 NRC Health Center Report of Employees' On-the-job Injuries 805 Health Center Respirator Medical Evaluation Questionnaire 806 Health Center Respiratory Certification Examination Physician Medical Evaluation 807 NRC Health Center Office of the Inspector General Sports Participation History 808*

NRC Health Center Office of the Inspector General Health Improvement Program Medical Clearancei 809 NRC Health Center FFS Examination Record 810 NRC Health Center Consent for Flexible Fiberoptic Sigmoidoscopy - Discontinue -

811 NRC Health Center Retention and disposal of Employee Medical Records 812 NRC Health Center Against Medical Advice Release 813 NRC Health Center Pre-travel Questionnaire 814 NRC Health Center Hepatitis A Vaccine Registration and Consent.

815 NRC Health Center Immunization Consent 817 N_RC Health Center Post-Exposure Prophylaxis - HIV Consent I

818 NRC Health Center Pneumococcal Vaccine Record and Consent 819 NRC Health Center Employ~e Immunization and Health Profile Record 820 NRC Health Center Progress Notes 821

NRC Health Center Problem List/Medication Sheet 822 NRC Health Center Flow Sheet for Blood Pressures 823 NRC Health Center Consent for Influenza Immunization 823A Nombre De Sito: NRC Consentimiento Para La Vacuna Contra La Gripe ( Influenza) 823C NRC Health Center Consent for 2009-2010 H1 N1 Inactivated Influenza (Flu Shot) 824 NRC Health Center Office of Investigations Health and Fitness Program Medical Clearance 825 NRC Health Center Consent for Release of Medical Records 826 NRC Health Center Agreement to Participate in NRC Wellness Program 827 NRC Small Business Review 828 NRC Small Business Subcontracting Plan Review 829 NRC Small Business Subcontracting Plan i

830 Report of Import 830A Report of Import - Continuation Sheet

831 Report of Export 831A Report of Export - Continuation Sheet 832 Limited English Proficiency Program Request for Domestic Translation Services 833 Form to Propose a Generic Issue (GI) 835 U. S. Nuclear Regulatory Commission Office of the Inspector General FAR Contractor Reporting Fon 836 Evidence Chain of Custody Document 840 Non-NRC Participant Course Feedback Form 850A Request for NRC Contractor Building Access Authorization 8508 Request for NRC Contractor Information Technology (IT) 850C Request for NRC Contractor Security Clearance 853 Occupant Emergency Program 860 Request for Facility Security Access Control Records i

860 Request for Facility Security Access Control Records 875 Request for Authorization ana Approval for Use of a Camera in U.S. NRC Facilities and Spaces 876 Request for Security Support at On/Off-site U. S. NRC Public Meetings/Hearings 876A Request for Security Support at On-site U. S. NRC Public Meetings/Hearings 8768 Request for Security Support at Off-site U. S. NRC Public Meetings/Hearings 877 U.S. NRC Security Support Supplement for Public Meetings/Hearings 878 U.S. NRC Request for Security Support Feedback Regarding Public Meetings/Hearings 879.

Federal Protective Service Modified Infrastructure Survey Tool (MIST) 880 NRC Escort Responsibility Agreement for NRC Contractors 880A (TTC)

NRC Escqrt RE:3sponsibility Agreement for NRC Contractors for th~ Technical Training Center (TTC C 881 U.S. NRC Recruiting & Outreach Activity Assessment 890 Single Positve Test i

891 Annual Reporting Form for Drug and Alcohol Tests 892 Annual Fatigue Reporting form

l 900 Safety & Occupational Health Program U. S. Nuclear Regulatory Commission (Poster) 901 Hazard Assessment & Personal Protective Equipment (PPE) Selection Worksheet

902 Office Safety Checklist 903 Chemical Inventory List 904 Hazard Abatement Plan 905 Job Hazard Analysis l

906 Record of Safety and Health Inspection Conferences 907 Report of Property Damage 908 Investigation of Reported Hazard 909 Indoor Air Quality Survey Request

. I

910 Indoor Air Quality Questionnaire 91.1,

. Log of Reported Unsafe or Unhealthful Working Conditions i

912 Safety and Occupational Health Inspection Report 912CA

, S~fety and Occupational Health Inspection Report Corrective Actions 9121R Safety and Occupational Health Inspection Report 916 Confined-Space Evaluation Worksheet 917 Confined Space Pre-Entry Checklist 918 Confined Space Entry Permit 920 Mishap Investigation Form 921

- Checklist for Lockout/Tagout Program 924 Powered Industrial Truck Daily Checklist 925 Powered Industrial Truck Operator Evaluation 926 Powered Industrial Truck Operator Training Record 927 Powered Industrial Truck Operator Refresher Training Record i

I 929 Occupational Safety and Health Committee Charter 930 Collateral Duty Safety Officer Appointment Letter 940CA Safety and Occupational Health Inspection Report Food Services - Corrective Actions 9401R Safety and Occupational Health Inspection Report Food Services -

i 950 Hepatitis B Vaccination: Training Confirmation 951 Hepatitis B Vaccination: Consent Form I

952 Hepatitis B Vaccination: Declination Form 953

Bloodborne Pathogens: Post Exposure Incident Checklist I

954 Bloodborne Pathogens: Employee Report of an Exposure Incident 955 Bloodborne Pathogens: Supervisor's Investigation of an Exposure Incident*

I 956 Bloodborne Pathogens: Exposure Incident Record, Medical Evaluation Form 957 Sharps Injury Log i

961 Respirator Fit Test Results 962 Respirator Cartridge Use Log

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963 Maintenance Log for Self-Contained Breathing Apparatus (SCBA) 964 Maintenance Log for Respirators 965 Results of Medical Examination for Respirator Certification 966 Respirator Training Certificate 1101 RIC Proposed Technical Session Submission Form 1102 RIC Proposed Digital Presentation Submission Form 1103 RIC Review and Evaluation Criteria for Technical Session Submissions 1104 RIC Review and Evaluation Criteria for Digital Presentation Submissions l

1105 RIC Speaker Confirmation Form 1106

. RIC External Speaker Agreement Form 1107 RIC Technical Session Setup Form 1108 RIC Digital Presentation Setup Form 1109 RIC Volunteer Application Form 1"200 Publication Planning & Progress Report

/*,

I 1220 Minimum Requirements for Handling Classified and Safeguards Information (Matrix Card) 12$0 ADAMS P8. Suggested Change Evaluation Criteria: *

l26b Enforcement Action Worksheet 1600 Environment Change Request (ECR) l i

ML18169A071: Difference between revisions

Latest revision as of 18:19, 5 January 2025

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