Form NRC 531 NRC 531 NRC Form 531, Request for Taxpayer Identification Number

NRC FORM 531
(11-2006)

U. S. NUCLEAR REGULATORY COMMISSION

REQUEST FOR TAXPAYER IDENTIFICATION NUMBER
In accordance with the Debt Collection Improvement Act of 1996, you are required to provide your taxpayer identification
number. This number may be used to make payments (refunds) or for purposes of collecting and reporting on any delinquent
amounts arising out of your relationship with the Federal Government
Please complete the applicable blocks and return the form to the NRC. Thank you for your assistance and cooperation. If you
have any questions, please contact us. Our telephone number is 301-415-7554.
Indicate the status of your business:

CORPORATION

CITY/STATE GOVERNMENT

INDIVIDUAL

PARTNERSHIP

FEDERAL GOVERNMENT

OTHER (Specify)

TAXPAYER IDENTIFICATION NUMBER,
SOCIAL SECURITY NUMBER, OR
INDIVIDUAL TAXPAYER IDENTIFICATION
NUMBER

NRC LICENSE NUMBER(S)

SIGNATURE - TAXPAYER REPRESENTATIVE

NRC LICENSEE OR APPLICANT

ADDRESS

TELEPHONE NUMBER

E-MAIL ADDRESS

APPROVED BY OMB: NO. 3150-0188
EXPIRES: MM/DD/YYYY
Estimated burden per response to comply with this mandatory collection request: 5 minutes. The information is required by NRC to process payments to
contractors. Send comments regarding burden estimate to the Records and FOIA/Privacy Service Branch (T-5 F52), U.S. Nuclear Regulatory Commission,
Washington, DC 20555-0001, or by internet e-mail to [email protected], and to the Desk Officer, Office of Information and Regulatory Affairs, NEOB-10202,
(3150-0188), Office of Management and Budget, Washington, DC 20503. If a means used to impose an information collection does not display a currently valid
OMB control number, the NRC may not conduct or sponsor, and a person is not required to respond to, the information collection.
PRIVACY ACT STATEMENT
Pursuant to 5 U.S.C. 552a(e)(3), enacted into law by Section 3 of the Privacy Act of 1974 (Public Law 93-579), the following statement is furnished to
individuals who supply information to the Nuclear Regulatory Commission (NRC) on NRC Form 531. This information is maintained in a system of records
designated as NRC-32 and described at 67 Federal Register 63796 (October 15, 2002), or the most recent Federal Register publication of the NRC's
"Republication of Systems of Records Notices" that is available at the NRC Public Document Room, 11555 Rockville Pike, Rockville, Maryland, and located in
the NRC's Agencywide Documents Access and Management System (ADAMS).
1.

AUTHORITY: 5 U.S.C. 552a(b)(12) (1999); 5 U.S.C. 5514 (1996); 15 U.S.C. 1681a(f) (1970); 26 U.S.C. 6103(m)(2) (2002); 31 U.S.C. 37, subchapters I
and II; 31 U.S.C. 3701(a)(3) (2001); 31 U.S.C. 3711 (1996); 31 U.S.C. 3716 (1999); 31 U.S.C. 3717 (1996); 31 U.S.C. 3718 (1997); 31 U.S.C. 3720A
(1996); 42 U.S.C. 2201 (1992); 42 U.S.C. 5841 (1996); Cash Management Improvement Act Amendments of 1992 (Pub. L. 102-589); Debt Collection
Improvement Act of 1996 (Public Law 104-134); 31 CFR Chapter IX, Parts 900-904; 10 CFR parts 15 (2002), 16 (1991), 170 and 171; Executive Order
9397, November 22, 1943; section 201 of Executive Order 11222.

2.

PRINCIPAL PURPOSE(S): To obtain taxpayer identification number/social security number/individual taxpayer identification number to enable the NRC to
collect delinquent debts.

3.

ROUTINE USES: Information from this form may be transmitted to: debt collection contractors and/or Federal agencies for collecting delinquent debts
and/or collection action on such debts; any Federal, State or local agencies to conduct authorized computer matching programs and to credit reporting
agencies; Treasury on past due nontax debts for the purpose of locating the debtor and/or effecting offset under Treasury Offset Program. Information may
be publicly disseminated regarding the identity of delinquent nontax debtors and the existence of nontax debts under the provisions of the Debt Collection
Improvement Act of 1996. The information may also be disclosed to an appropriate Federal, State, local or Foreign agency in the event the information
indicates a violation or potential violation of law and in the course of an administrative or judicial proceeding. In addition, this information may be
transferred to an appropriate Federal, State, local and Foreign agency to the extent relevant and necessary for an NRC decision about you or to the extent
relevant and necessary for that agency's decision about you. Information from this form may also be disclosed, in the course of discovery under a
protective order issued by a court of competent jurisdiction, and in presenting evidence, to a Congressional office to respond to their inquiry made at your
request, or to NRC-paid experts, consultants, and others under contract with the NRC, on a need-to-know basis.

4.

WHETHER DISCLOSURE IS MANDATORY OR VOLUNTARY AND EFFECT ON INDIVIDUAL OF NOT PROVIDING INFORMATION: It is mandatory
that you furnish the requested information pursuant to the Debt Collection Improvement Act of 1996 (Public Law 104-134). If you do not provide the
requested information, we may no longer be able to conduct business with you, and if you are due a refund, you may give up your rights to your refund.

5.

SYSTEM MANAGER AND ADDRESS: Director, Division of Financial Management, Office of the Chief Financial Officer, U.S. Nuclear Regulatory
Commission, Washington, DC 20555-0001.