Form NRC Form 509 NRC Form 509 Statement of Estimated Fees for Freedom of Information A

NRC FORM 509

U.S. NUCLEAR REGULATORY COMMISSION REQUEST NUMBER
APPROVED BY OMB: 3150-0043
FOIA/PA EXPIRES: MM/DD/YYYY

(M-YYYY)

STATEMENT OF ESTIMATED FEES FOR
FREEDOM OF INFORMATION ACT (FOIA) REQUEST
REQUESTER

NRC CONTACT

-

DATE

TELEPHONE

Pursuant to the NRC's regulations, 10 CFR 9.40, 52 FR 49350, the NRC notifies a requester when estimated applicable fees exceed
$25.00 or a limit stated in an FOIA request. The estimated fees for processing your FOIA request are noted below. If you wish to rescope your request to reduce fees, you may telephone the NRC contact identified above to discuss re-scoping the request. Otherwise,
please provide a written response on required action noted below. If the NRC does not receive notice from you on re-scoping your
request or the required written response within 10 working days from the date of this notice, the NRC will presume that you have no
further interest in NRC processing your request and will close the file on your request.

ESTIMATED FEES
SEARCH
REVIEW
DUPLICATION *
TOTAL
* Duplication estimate is based on the assumption that you want copies of disclosed records mailed directly to you.
Please specify paper copy or a CD-Rom. If you choose a CD-Rom, the cost will be the cost of the CD-Rom to the NRC.
If you prefer, the NRC will make disclosed records available, if appropriate, at the NRC Electronic Reading Room
accessible from NRC's web site at http://www.nrc.gov/reading-rm.html. Please note your preference in the Response
section below.
Please note the comments provided on the attached NRC Form 509A.
Your request for a waiver or reduction of fees does not provide sufficient information under 10 CFR 9.41 for theNRC
to make a determination to waive or reduce fees. If you want the NRC to consider this matter further, please submit
a written request pursuant to 10 CFR 9.41 within 10 working days from the receipt of this notice.
REQUIRED ACTION
Please agree by signing below to pay fees as high as estimated by signing and dating the Response section of this
form and returning the form to the NRC contact identified above at the U.S. Nuclear Regulatory Commission,
Washington, DC, 20555-0001, or by fax to (301) 415-5130, within 10 working days from the date of this notice.
Please provide an advance payment of the estimated fees by one of the methods described on the attached NRC
Form 509A within 10 working days from the date of this notice. Any overpayment of fees will be refunded to you.
SIGNATURE DATE

SIGNATURE - FOIA/PA SPECIALIST

RESPONSE
As required above, I agree to pay fees as high as estimated. I agree to pay estimated search fees even if the NRC
conducts an unsuccessful search for responsive records or determines records located are exempt from disclosure.
I prefer that copies of disclosed records be provided as stated below.
Mailed directly to me.

Placed in the NRC Electronic Reading Room.

Paper copy
CD-Rom
SIGNATURE - FOIA/PA REQUESTER

NRC FORM 509 (M-YYYY)

DATE

Estimated burden per response to comply with this mandatory collection request: 6 minutes. This form is used to notify a requester of the amount of the estimated fees and to obtain the
requester's agreement to pay the fees. Send comments regarding burden estimate to the Information 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, (3150-0043), Office of Management
and Budget, Washington, DC20503. 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.

NRC FORM 509A

U.S. NUCLEAR REGULATORY COMMISSION

(M-YYYY)

STATEMENT OF ESTIMATED FEES FOR
FREEDOM OF INFORMATION ACT (FOIA) REQUEST
COMMENTS

REQUEST NUMBER

FOIA/PA -

-

Payment may be made to the USNRC by check or credit card. If paying via credit card, the enclosed NRC
Form 629 must be completed and forwarded to the address listed below. Please be sure to reference the
number assigned to your request (i.e., FOIA/PA-2003-0120) on your check or in the box marked "Invoice
Number or Description" on the enclosed NRC Form 629 if you are paying by credit card.
Your check or NRC Form 629 should be mailed to the attention of the NRC Contact identified on the
previous page at the following address:
Mail Stop T-5 F09
USNRC
11555 Rockville Pike
Rockville, MD 20852-2738
Payments sent via an overnight delivery method should be sent to the NRC Contact identified on the
previous page to the same address.
COMMENTS

NRC FORM 509A (M-YYYY)

NRC FORM 509A

U.S. NUCLEAR REGULATORY COMMISSION

(M-YYYY)

STATEMENT OF ESTIMATED FEES FOR
FREEDOM OF INFORMATION ACT (FOIA) REQUEST
COMMENTS
COMMENTS

NRC FORM 509A (M-YYYY)

REQUEST NUMBER

FOIA/PA -

-