Information Collection

NRC Form 136, Security Termination Statement

IC 33297 under ICR 200704-3150-003 · OMB 3150-0049.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3150-0049 can be found here:

Documents and Forms

Document Name Document Type
Form NRC Form 136 NRC Form 136, Security Termination Statement Form
NRC Form 136 NRC Form 136, Security Termination Statement NRC Form 136.pdf www.nrc.gov/reading-rm/doc-collections/forms/nrc136.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	NRC Form 136, Security Termination Statement	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 10 CFR 9

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	NRC Form 136	NRC Form 136, Security Termination Statement	NRC Form 136.pdf	http://www.nrc.gov/reading-rm/doc-collections/forms/nrc136.pdf	No		Fillable Printable

Line of Business: Defense and National Security

Subfunction: Operational Defense

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 75	Number of Respondents for Small Entity: 0

Affected Public: Federal Government

Percentage of Respondents Reporting Electronically: 98 %

	Approved	Previously Approved
Annual Number of Responses for this IC	225	225
Annual IC Time Burden (Hours)	23	23
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.