Form NRC-671 NRC Form 671, Request for Review of a Customer Satisfact

NRC FORM 671

U.S. NUCLEAR REGULATORY COMMISSION

(MM-YYYY)

REQUEST FOR REVIEW OF A CUSTOMER SATISFACTION SURVEY
UNDER GENERIC CLEARANCE
TITLE OF SURVEY

OMB APPROVAL NUMBER

3150 - 0197
REQUESTED RESPONSE DATE

ESTIMATED NUMBER OF RESPONSES

BURDEN HOURS PER RESPONSE

TOTAL ESTIMATED BURDEN HOURS

ESTIMATED SURVEY COMPLETION DATE

DESCRIPTION AND OBJECTIVES OF SURVEY

OFFICE CONTACT (Name and Title)

OCIO APPROVAL
NRC Clearance Officer

TELEPHONE NUMBER

DATE

SIGNATURE

OMB APPROVAL
SIGNATURE OF OMB OFFICIAL

NRC FORM 671 (MM-YYYY)

DATE

PRINTED ON RECYCLED PAPER

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