Form NRC Form 754 NRC Form 754 BRC Firn 754, Armed Security Personnel Firearms Backgrou

NRC FORM 754
(10-2006)
10 CFR 73.18

U.S. NUCLEAR REGULATORY COMMISSION

ARMED SECURITY PERSONNEL
FIREARMS BACKGROUND CHECK

Transaction Serial Number

APPROVED BY OMB: NO. 3150-xxxx. Estimated burden per response
to comply with this mandatory collection request: 20 minutes. NRC uses
the information to verify that security personnel protecting NRC-regulated
entities are not prohibited from receiving, possessing, transporting,
importing, or using covered weapons as part of the performance of their
official duties. Forward comments regarding the burden estimate to the
Records and FOIA/Privacy Services Branch (T-5 F52), U.S. Nuclear
Regulatory Commission, Washington, DC 20555-0001, or by e-mail to
[email protected], and to the Desk Officer, Office of Information and
Regulatory Affairs, NEOB-10202, (3150-xxxx), 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.

Warning: Security personnel protecting NRC-regulated facilities, radioactive material, or other property are not authorized to receive,
possess, transport, import, or use firearms pursuant to § 161A. of The Atomic Energy Act of 1954, as amended, 42 U.S.C. § 2201a, if
prohibited under Federal or State law. The information you provide will be used to verify that you are not prohibited under Federal or State
law from receiving, possessing, transporting, importing, or using any firearms. Prepare in original only. Must be completed personally by
individual. All entries must be in ink. Please type or print all information. Read the Important Notices, Instructions, and Definitions on this
form.
1. Individual's Full Name
Last Name

First Name

Middle Name (If no middle name state "NMN")

2. Other Previously Used Names (e.g. Maiden) (Last, First, or Middle)

3. Current Residence Address (Cannot be a post office box.)
Number and Street Address
City

County

State

Zip Code

4. Current Duty Station Address (Post office boxes allowed.) (For transportation duties enter specific State(s) or "CONUS".)
Number and Street Address
City
County
State

5. Place of Birth
U.S. City/State

Foreign Country

6. Height
Ft.

7. Weight

In.

8. Gender
M

Zip Code

9. Birth Date
Month
Day

Year

F

10. Social Security Number

11. Unique Personal Idenification Number (UPIN), if applicable
(see instruction 4)

12. Race (Ethnicity) (Check one or more boxes)
American Indian or Alaska Native

Black or African American

Native Hawaiian or Other Pacific Islander

Hispanic or Latino

Asian

White

13. State of Residence

(See Definition 4.)

14. What is your country of citizenship ?
United States of America

(List/check more than one, if applicable.)
Other (specify)

15. If you are not a citizen of the United States, what is your U.S. - issued alien number or admission number?

16. If you are a nonimmigrant alien, what exception do you fall under as described in Important Notice 3, Exception 2? (Specify the documentation
showing an exemption to the nonimmigrant alien prohibition.)

I certify that the answers above are true and correct. I have read and understand the Important Notices, Instructions, and
Definitions for this form. I understand that making any false oral or written statement is a crime punishable as a felony.
17. Security Personnel's Signature

NRC FORM 754 (10-2006)

18. Certification Date

PRINTED ON RECYCLED PAPER

Important Notices
1.

Purpose of the Form: The information and certification on this
form are designed to support a verification that security
personnel protecting U.S. Nuclear Regulatory Commission
(NRC) regulated facilities, radioactive material, or other
property are not prohibited from receiving, possessing,
transporting, or using firearms as part of the performance of
their official duties under § 161A. of the Atomic Energy Act of
1954, as amended (AEA), 42 U.S.C. § 2201a. Submission of
this form is mandatory for security personnel of licensees and
certificate holders who apply to the NRC for Section 161A.
authority. Failure to submit this form will result in the individual
being denied access to firearms as part of their official security
duties at NRC-regulated entities.

Exception 2: A nonimmigrant alien is not prohibited from
possessing or receiving a covered weapon as part of their
official duties at NRC regulated facilities if the alien: (1) meets
the exceptions of 18 U.S.C. § 922(y)(2)(B), (y)(2)(C), or
(y)(2)(D); or (2) has received a waiver from the Attorney
General of the United States (See 18 U.S.C. § 922(y)(3) for
additional information on waivers.)
4.

Evaluation of the information contained in this form will permit
the NRC to verify that individuals who are prohibited from
possessing or receiving any firearms under Federal or State
law do not possess or receive firearms (including enhanced
weapons) as part of their current or proposed official duties as
security personnel. This determination is required of all
security personnel protecting NRC-regulated facilities,
radioactive material, or other property.
2.

3.

Background Checks: Section 161A. requires that security
personnel receiving, possessing, transporting, or using a
covered weapon shall be subject to a background check by the
Attorney General, based on fingerprints and including a
background check under section 103(b) of the Brady Handgun
Violence Prevention Act (Brady Act), Public Law 103-159, 18
U.S.C. § 922(t), to determine whether the person is prohibited
from possessing or receiving firearms under Federal or State
law. The Brady Act provides for the submission of information
to the Federal Bureau of Investigation's (FBI's) National Instant
Criminal Background Check Systems (NICS) to verify that an
individual is not prohibited under Federal or State law from
possessing or receiving firearms.
Prohibited Persons: Generally, 18 U.S.C. § 922 prohibits the
shipment, transportation, receipt, or possession in or affecting
interstate commerce of firearms by anyone who: (1) has been
convicted of a misdemeanor crime of domestic violence; (2)
has been convicted of a felony, or any other crime, punishable
by imprisonment for a term exceeding one year (this does not
include State misdemeanors punishable by imprisonment of
two years or less); (3) is a fugitive from justice; (4) is an
unlawful user of, or addicted to, marijuana or any depressant,
stimulant, or narcotic drug, or any controlled substance; (5) has
been adjudicated mentally defective or has been committed to
a mental institution; (6) has been discharged from the Armed
Forces under dishonorable conditions; (7) has renounced his or
her U.S. citizenship; (8) is an alien illegally in the United States
or a nonimmigrant alien; or (9) is subject to certain restraining
orders. Furthermore, § 922 prohibits the shipment,
transportation, or receipt of firearms to anyone who is under an
indictment or information in any court for a felony, or any other
crime, punishable by imprisonment for a term exceeding one
year.
Exception 1: A person who has been convicted of a felony, or
any other crime, for which the judge could have imprisoned the
person for more than one year, or has been convicted of a
misdemeanor crime of domestic violence, is not prohibited from
receiving, possessing, transporting, importing, or using covered
weapons if: (1) under the law of the jurisdiction where the
conviction occurred, the person has been pardoned, the
conviction has been expunged or set aside, or the person has
had certain civil rights (the right to vote, sit on a jury, and hold
public office) restored AND (2) the person is not prohibited by
the law of jurisdiction where the conviction occurred from
receiving or possessing firearms. A person who has been
convicted of a misdemeanor crime of domestic violence also is
not prohibited unless: (1) the individual was represented by a
lawyer or gave up the right to a lawyer; and (2) if the person
was entitled to a jury, was tried by a jury, or gave up the right to
a jury trial.

Restraining Order: Under 18 U.S.C. § 922, firearms may not
be possessed or received by persons subject to a court order
that: (1) was issued after a hearing which the person received
actual notice of and had an opportunity to participate in; (2)
restrains such person from harassing, stalking, or threatening
an intimate partner or child of such intimate partner or person,
or engaging in other conduct that would place an intimate
partner in reasonable fear of bodily injury to the partner or child;
and (3)(i) includes a finding that such person represents a
credible threat to the physical safety of such intimate partner or
child; or (ii) by its terms explicitly prohibits the use, anticipated
use, or threatened use of physical force against such intimate
partner or child that would reasonably be expected to cause
bodily injury.

Instructions to Security Personnel
1.

Individuals must personally complete this form and certify (sign)
that the information on this form is true and correct.

2.

If the individual is a member of the Armed Forces on active
duty and is receiving, possessing, transporting, or using
covered weapons in the State where his or her permanent duty
station is located, but does not reside at his or her permanent
duty station, the security personnel must list his or her
permanent duty station address in the response to question 4
and his or her residence address in response to question 3.

3.

If you are a U.S. citizen with two States of residence, you
should list your current residence address in response to
question 3.

4.

Unique Personal Identification Number (UPIN): If you have
a UPIN issued to you by the FBI's NICS Voluntary Appeal File
(based upon previous firearms transactions or based upon
previous firearms security background checks), you should
enter the UPIN under question 11. Entry of a UPIN is
voluntary. However, failure to provide your issued UPIN may
result in a "delayed" or "denied" NICS response .

5.

NICS Responses: The FBI will provide a "proceed," "delayed,"
or "denied" NICS response and a NICS transaction number to
the NRC that will be forwarded to you via your submitting
licensee or certificate holder.

Definitions
1.

Under indictment or information or conviction in any court:
An indictment, information, or conviction in Federal, State, or
local court.

2.

Misdemeanor Crime of Domestic Violence: A Federal, State,
or local offense that is a misdemeanor under Federal or State
law and has, as an element, the use or attempted use of
physical force, or the threatened use of a deadly weapon,
committed by a current or former spouse, parent, or guardian of
the victim, by a person with whom the victim shares a child in
common, by a person who is cohabiting with, or has cohabited
with the victim as a spouse, parent, or guardian, or by a person
similarly situated to a spouse, parent, or guardian of the victim.
The term includes all misdemeanors that have as an element
the use or attempted use of physical force or the threatened
use of a deadly weapon (e.g., assault and battery), if the
offense is committed by one of the defined parties.

3.

Intimate Partner: An "intimate partner" of a person is: the
spouse or former spouse of the person, the parent of a child of
the person, or an individual who cohabitates or has cohabited
with the person.

4.

State of Residence: The State in which an individual resides.
An individual resides in a State if he or she is present in a State
with the intention of making a home in that State. If an
individual is a member of the Armed Forces on active duty, his
or her State of residence also is the State in which his or her
permanent duty station is located. An alien who is legally in the
United States is a resident of a State only if the alien is residing
in the State and has resided in the State continuously for at
least 90 days immediately prior to the date of submission of this
form.

5.

Nonimmigrant Alien: An alien in the United States in a
nonimmigrant classification. The definition includes, in large
part, persons traveling temporarily in the United States for
business or pleasure, persons studying in the United States
who maintain a residence abroad, and certain foreign workers.
The definition does NOT include permanent resident aliens.

6.

Unique Personal Identification Number (UPIN): For
individuals approved to have information maintained about
them in FBI's NICS Voluntary Appeal File (VAF), NICS will
provide them with a UPIN for their use in future firearms
transaction or firearms security background checks.

7.

Covered Weapon: Covered weapon means any handgun, rifle,
shotgun, short-barreled shotgun, short-barreled rifle,
semi-automatic assault weapon, machinegun, ammunition for
any such weapon, or large capacity ammunition feeding device
as specified under section 161A. The terms "handgun, rifle,
shotgun, short-barreled shotgun, short-barreled rifle,
semi-automatic assault weapon, machinegun, ammunition, and
large capacity ammunition feeding device" have the same
meaning provided for these terms in 18 U.S.C. § 921(a).

Privacy Act Information
Pursuant to 5 U.S.C. 552(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 754.
This information is maintained in a system of records
designated as NRC-39, described at 71 Federal Register
59642 (October 10, 2006), 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 or located in NRC's
Agencywide Documents Access and Management System
(ADAMS).
1. AUTHORITY: 42 U.S.C. 2201a.
2. PRINCIPAL PURPOSE(S): This form is used to perform a
background check to verify that an individual is not prohibited
from receiving, possessing, transporting, importing, or using
covered weapons as part of the performance of their official
duties.

3. ROUTINE USE(S): This information will be used to
determine eligibility to receive, possess, transport, or import
covered weapons. 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 necessar y for it to carry out its
responsibilities under 161A. of the Atomic Energy Act of 1954,
as amended. Information 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 . W H E T H E R D I S C L O S U R E I S M AN D AT O R Y O R
VOLUNTARY AND EFFECT ON INDIVIDUAL OF NOT
PROVIDING INFORMATION: Disclosing this information is
mandatory for security personnel of licensees and certificate
holders who apply to the NRC for authority to possess covered
weapons under section 161A. of the Atomic Energy Act of
1954, as amended. Failure to submit a completed form will
result in the individual being denied access to any covered
we a p o n s a s p a r t o f t h e i r o f f i c i a l s e c u r i t y d u t i e s a t
NRC-regulated entities. The social security number is required
to verify the individual's identity to facilitate the background
check requirements.
5. SYSTEM MANAGER(S) AND ADDRESS: Director,
Division of Facilities and Security, Office of Administration, U.S.
Nuclear Regulatory Commission, Washington, DC 20555-0001.