Information Collection

NRC Forms 850A, 850B, and 850C

IC 209500 under ICR 201612-3150-003 · OMB 3150-0218.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3150-0218 can be found here:

Documents and Forms

Document Name Document Type
Form NRC Form 850A NRC Forms 850A, 850B, and 850C Form and Instruction
NRC Form 850A Request for NRC Contractor Building Access Authorization NRC 850A REVISED.pdf Form and Instruction
NRC Form 850B Request for NRC Contractor Information Technology Access NRC 850B REVISED.pdf Form and Instruction
NRC Form 850C Request for NRC Contractor Security Clearance NRC 850C REVISED.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	NRC Forms 850A, 850B, and 850C	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	NRC Form 850A	Request for NRC Contractor Building Access Authorization	NRC 850A REVISED.pdf	Yes	No	Fillable Printable
Form and Instruction	NRC Form 850B	Request for NRC Contractor Information Technology Access Authorization	NRC 850B REVISED.pdf	Yes	No	Fillable Printable
Form and Instruction	NRC Form 850C	Request for NRC Contractor Security Clearance	NRC 850C REVISED.pdf	Yes	No	Fillable Printable

Line of Business: General Government

Subfunction: Central Personnel

Privacy Act System of Records
Title: NRC-39, Personnel Security Records and Associated Files	FR Citation: 77 FR 67231

Number of Respondents: 500	Number of Respondents for Small Entity: 230

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	500	500
Annual IC Time Burden (Hours)	85	85
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.