Form N-71 IAEA Form N-71

APPROVED BY OMB: NO. 3150-0056

CONFIDENTIAL
WHEN COMPLETED

EXPIRES: 08/31/2011

Estimated burden per response to comply with this mandatory collection
request: 360 hours. NRC is required to collect this information for reporting to
IAEA from facility licensees appearing on the U.S. Eligible List. Send
comments regarding burden estimate to the Records and FOIA/Privacy
Services Branch (T-5 F53), 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,
(3150-0056), 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.

INTERNATIONAL ATOMIC ENERGY AGENCY
DEPARTMENT OF SAFEGUARDS AND INSPECTION

DESIGN INFORMATION
QUESTIONNAIRE *
IAEA USE ONLY

The purpose of this document is to obtain the
facility design information required by the
Agency in order to discharge its safeguards
responsibilities. It will also serve as a check list
for examination of design information by Agency
inspector(s). If, in any area, insufficient space is
available, add additional sheets to the extent
necessary.

The "Confidential" marking on this form is for
IAEA purposes only. It indicates that the IAEA
considers the information in the completed form
to be 'safeguards confidential' and is not to be
confused with any U.S. security classification.

IAEA USE ONLY
COUNTRY
COUNTRY
OFFICER
TYPE
DATE OF
INITIAL DATA
VERIFICATION

* Questions which are not applicable may be left
unanswered.

LAST REVIEWING
AND UPDATING

CONFIDENTIAL
WHEN COMPLETED
N-71 (8-2008)

PRINTED ON RECYCLED PAPER

DATE:

ALL FACILITIES
GENERAL INFORMATION
1. NAME OF THE FACILITY
(Include usual abbreviation)
2. LOCATION AND POSTAL ADDRESS

3. OWNER (legally responsible)

4. OPERATOR (legally responsible)

5. DESCRIPTION (main features only)

6. PURPOSE

7. STATUS
(planned; under construction; in operation)

8. CONSTRUCTION SCHEDULE DATES
(if not in operation)

Start of Construction

Commissioning

Operation

9. NORMAL OPERATING MODE
(days only, two-shift, three-shift; number of
days/annum, etc.)
10. FACILITY LAYOUT
(structural containment, fences, access,
nuclear material storage areas,
laboratories, waste disposal areas, routes
followed by nuclear material, experimental,
and test areas, etc.)

DRAWING(S) ATTACHED UNDER REF. NOS.

11. SITE LAYOUT
(site plan showing in sufficient detail; location,
premises and perimeter of facility, other
buildings, roads, railways, rivers, etc.

DRAWING(S) AND/OR MAPS ATTACHED UNDER REF. NOS.

12. NAMES AND/OR TITLE AND ADDRESS OF
RESPONSIBLE OFFICERS
(for nuclear material accountancy and
control and contact with the Agency. If
possible, attach organization charts
showing position of officers)
N-71 (8-2008)

CONFIDENTIAL

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