Form NRC Form 790 NRC Form 790 Classification Record

PLEASE COMPLETE THIS FORM AND SAVE THE PDF FILE TO YOUR COMPUTER. CLICK THE
INSTRUCTIONS: SEND BUTTON BELOW. FORM WILL BE SUBMITTED ELECTRONICALLY TO THE INFORMATION
SECURITY BRANCH RECORD CLASSIFICATION ACTION RESOURCE MAILBOX.
NRC FORM 790
(MM-YYYY)
NRCMD 12.2

U.S. NUCLEAR REGULATORY COMMISSION

CLASSIFICATION RECORD
Authorized classifiers MUST COMPLETE THIS FORM for each
classification or declassification review performed. Enter only the
number of characters required in each space.

APPROVED BY OMB: NO. 3150-0052

EXPIRES: (MM/DD/YYYY)
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 13526. 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 Infocollects.
[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
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.
2. AUTHORIZED CLASSIFIER'S NUMBER

1. FROM: AUTHORIZED CLASSIFIER'S NAME (Type or print)

TO:
DIVISION OF SECURITY OPERATIONS
INFORMATION SECURITY BRANCH

5. DATE OF DOCUMENT
(MM/DD/YY)

4. DOCUMENT TITLE (Unclassified)

3. FORM COMPLETION DATE
(MM/DD/YY)

11. DECLASSIFICATION INSTRUCTIONS
1. ORIGINAL DECISION

6. OFFICE SYMBOL

7. TYPE OF REVIEW

CODE DESCRIPTION

DESCRIPTION

1

DATE (10 YEARS OR
LESS) (Complete 13)

2

8. REASON FOR REVIEW

CODE DESCRIPTION

CODE

EVENT (Complete 14)

CLASSIFICATION
(Skip 8, Go to 9)

1

MANDATORY
REVIEW

4

2

DECLASSIFICATION
(Complete 8, Skip 9)

FOIA
REQUEST

2

SYSTEMATIC
REVIEW

5

FOIA
APPEAL

CODE

CHALLENGE
REQUEST

6

AUTOMATIC
DECLASSIFICATION

2 EVENT (Complete 14)

3

EXECUTIVE ORDER 13526
SECTION 1.4

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

CODE DESCRIPTION
7

UNCLASSIFIED
(Complete
13,15, 16)

3

10-YEAR EXEMPT (Complete 13)

4

25-YEAR EXTENSION (Complete 13)

5

EXTENSION (Complete13)

2. DERIVATIVE DECISION
DESCRIPTION

1 DATE (10 YEARS OR LESS) (Complete 13)
3 10-YEAR EXEMPT (Complete 12 and 13)

5 OADR SOURCE (Complete 12 and 13)

4 25-YEAR EXTENSION (Skip 12, Go to 13)

6 NO FUTURE ACTION

12. DATE OF OADR SOURCE,
CLASSIFICATION GUIDE
OR OTHER SOURCE DOCUMENT
(MM/DD/YY)

13. DECLASSIFICATION OR REVIEW DATE
(MM/DD/YY)

14. EVENT

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

15. NUMBER OF PAGES DECLASSIFIED

NRC FORM 790 (MM-YYYY)

DESCRIPTION

CODE DESCRIPTION

1

9. REASON FOR CLASSIFICATION

CODE

Submit by Email

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-h (see Executive Order 13526, Section 1.4).

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.