APPROVED BY OMB: NO. 3150-0043 EXPIRES: 10/31/2024

Estimated burden per response to comply with this collection request: 8 minutes. This form may be used by FOIA and Privacy Act requesters to provide verification of their identity and/or provide third-party authorization. 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 e-mail to Infocollects.Resource@nrc.gov, and the OMB reviewer at: OMB Office of Information and Regulatory Affairs, (3150-0043), Attn: Desk Officer for the Nuclear Regulatory Commission, 725 17th Street NW, Washington, DC 20503; e-mail: 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.

Privacy Act Statement for FOIA Requests: https://www.nrc.gov/reading-rm/foia/privacy-foia.html