Form 790 Form 790 NRC Form 790

EXPIRES: MM/DD/YYYY
U.S. NUCLEAR REGULATORY COMMISSION APPROVED BY OMB: NO. 3150-0052
Estimated burden per response to comply with this mandatory information collection request: 6 minutes. This
submittal is required by NRC to report classification or declassification of documents in accordance with Executive
Order 12958. Send comments regarding burden estimate to the Records and FOIA/Privacy Services 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,
(3150-0052), Office of Management and Budget, Washington, DC 20503. If a means used to impose an
Authorized classifiers MUST COMPLETE THIS FORM for each
classification or declassification review performed. Enter only the
information collection does not display a currently valid OMB control number, the NRC may not conduct or sponsor,
number of characters required in each space.
and a person is not required to respond to, the information collection.
1. FROM: AUTHORIZED CLASSIFIER'S NAME (Type or print)
2. AUTHORIZED CLASSIFIER'S NUMBER
3. FORM COMPLETION DATE
TO:
NRC FORM 790
(M-YYYY)
NRCMD 12.2

CLASSIFICATION RECORD

MONTH

DIVISION OF FACILITIES AND SECURITY
INFORMATION SECURITY BRANCH
4. DOCUMENT TITLE (Unclassified)

5. DATE OF DOCUMENT
MONTH

DAY

YEAR

1

DATE (10 YEARS OR
LESS) (Complete 13)

3

10-YEAR EXEMPT
(Complete 13)

2

EVENT (Complete 14)

4

25-YEAR EXTENSION
(Complete 13)

2. DERIVATIVE DECISION
CODE DESCRIPTION

CODE
1

CLASSIFICATION
(Skip 8, Go to 9)

2

DECLASSIFICATION
(Complete 8, Skip 9)

CODE

DESCRIPTION

CODE

1

MANDATORY
REVIEW

4

4

25-YEAR EXTENSION
(Skip 12, Go to 13)

DESCRIPTION

2

EVENT (Complete 14)

5

FOIA
REQUEST

3

10-YEAR EXEMPT
(Complete 12 and 13)

OADR SOURCE
(Complete 12 and 13)

6

NO FUTURE ACTION (RD)

SYSTEMATIC
REVIEW

5

FOIA
APPEAL

EXECUTIVE ORDER 12958

3

CHALLENGE
REQUEST

6

AUTOMATIC
DECLASSIFICATION

SECTION 1.5 ________

12. DATE OF OADR SOURCE, CLASSIFICATION
GUIDE OR OTHER SOURCE DOCUMENT
MONTH

DAY

YEAR

EXTENSION
(Complete 13)

DESCRIPTION

DATE (10 YEARS OR
LESS) (Complete 13)

2

9. REASON FOR CLASSIFICATION

CODE

5

1
8. REASON FOR REVIEW

DESCRIPTION

YEAR

11. DECLASSIFICATION INSTRUCTIONS
1. ORIGINAL DECISION
CODE DESCRIPTION
CODE DESCRIPTION
CODE DESCRIPTION

6. OFFICE SYMBOL

7. TYPE OF REVIEW

DAY

13. DECLASSIFICATION OR REVIEW DATE
MONTH

DAY

YEAR

14. EVENT
10. CLASSIFICATION LEVEL
CODE

DESCRIPTION

CODE

DESCRIPTION

CODE

DESCRIPTION

1

TS-NSI

3

C-NSI

5

S-RD

2

S-NSI

4

TS-RD

6

C-RD

NRC FORM 790 (M-YYYY)

CODE DESCRIPTION
7

UNCLASSIFIED
(Complete
13,15, 16)

15. NUMBER OF PAGES DECLASSIFIED

16. NAME OF INDIVIDUAL COMPLETING FORM, IF DIFFERENT FROM CLASSIFIER

PRINTED ON RECYCLED PAPER

INSTRUCTIONS FOR COMPLETING NRC FORM 790
Items 1-3

Self-Explanatory

Item 4

Insert Unclassified Document Title: Begin the title in the first block. Insert one letter or
number in each block. Leave a block blank to indicate a space. Abbreviations are
acceptable.

Item 5

Insert the date the document was originated or signed.

Item 6

Self-Explanatory.

Item 7

Indicate whether you are classifying or declassifying the document.

Item 8

Self-Explanatory.

Item 9

Insert the appropriate letter designator a-g (see Executive Order 12958, Section 1.5).

Items 10-11

Self-Explanatory.

Item 12

If the source document is marked, "Declassify on OADR," insert the date of that document.

Item 13

Insert the date on which the document should be declassified or reviewed for classification
extension.

Item 14

Self-Explanatory.

Item 15

Self-Explanatory.

Item 16

Self-Explanatory.