Form NRC Form 531 NRC Form 531 Request for Taxpayer Identification Number

NRC FORM 531
(MM-YYYY)

U. S. NUCLEAR REGULATORY COMMISSION

REQUEST FOR TAXPAYER IDENTIFICATION NUMBER

In accordance with the Debt Collection Improvement Act of 1996, you are required to provide your taxpayer identification
number. This number may be used to make payments (refunds) or for purposes of collecting and reporting on any delinquent
amounts arising out of your relationship with the Federal Government
Please complete the applicable blocks and fax the completed form to (301) 415-5387. Thank you for your assistance and
cooperation. If you have any questions, please contact us. Our telephone number is (301) 415-7554.
Indicate the status of your business:

CORPORATION

CITY/STATE GOVERNMENT

INDIVIDUAL

PARTNERSHIP

FEDERAL GOVERNMENT

OTHER (Specify)

TAXPAYER IDENTIFICATION NUMBER,
SOCIAL SECURITY NUMBER, OR
INDIVIDUAL TAXPAYER IDENTIFICATION
NUMBER

NRC LICENSE NUMBER(S)

SIGNATURE - TAXPAYER REPRESENTATIVE

NRC LICENSEE OR VENDOR

BILLING ADDRESS

BILLING TELEPHONE NUMBER

BILLING E-MAIL ADDRESS

APPROVED BY OMB: NO. 3150-0188

EXPIRES: (MM/DD/YYYY)

Estimated burden per response to comply with this mandatory collection request: 5 minutes. The information is required by NRC to process payments to
contractors. Send comments regarding burden estimate to the Information Services Branch, Information Collections Team, (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, (3150-0188), 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.
PRIVACY ACT STATEMENT
Pursuant to 5 U.S.C. 552a(e)(3), enacted into law by Section 3 of the Privacy Act of 1974 (Public Law 93-579), the following statement is furnished to individuals
who supply information to the Nuclear Regulatory Commission (NRC) on NRC Form 531. This information is maintained in a system of records designated as
NRC-32 and described at 75 Federal Register 57356 (September 20, 2010), or the most recent Federal Register publication of the NRCs Systems of Records
Notices that is located in the NRCs Agencywide Documents Access and Management System (ADAMS).
1.

AUTHORITY: 5 U.S.C. 552a; 5 U.S.C. 5514; 15 U.S.C. 1681; 26 U.S.C. 6103; 31 U.S.C. Chapter 37; 31 U.S.C. 6501-6508; 42 U.S.C. 2201; 42 U.S.C.
5841; 31 CFR 900-904; 10 CFR Parts 15, 16, 170, 171; Executive Order (E.O.) 9397, as amended by E.O. 13478; and E.O. 12731.

2. PRINCIPLE PURPOSE(S): To obtain taxpayer identification number/social security number/individual taxpayer identification number to enable the NRC to
process payments and collect/report delinquent debts.
3. ROUTINE USES: Information from this form may be transmitted to: debt collection contractors and/or Federal agencies for collecting delinquent debts and/
or collection action on such debts; any Federal, State or local agencies to conduct authorized computer matching programs and to credit reporting agencies;
Treasury on past due nontax debts for the purpose of locating the debtor and/or effecting offset under Treasury Offset Program. Information may be publicly
disseminated regarding the identity of delinquent nontax debtors and the existence of nontax debts under the provisions of the Debt Collection Improvement
Act of 1996. Information may be disclosed in accordance with any of the Routine Uses listed in the Prefatory Statement of General Routine Uses, including
to an appropriate Federal, State, local or Foreign agency in the event the information indicates a violation or potential violation of law; in the course of an
administrative or judicial proceeding; to an appropriate Federal, State, local and foreign agency to the extent relevant and necessary for an NRC decision
about you or to the extent relevant and necessary for that agency's decision about you; in the course of discovery under a protective order issued by a court
of competent jurisdiction, and in presenting evidence; to a Congressional office to respond to their inquiry made at your request; to NRC-paid experts,
consultants, and others under contract with the NRC, on a need-to-know basis; or to appropriate persons and entities for purposes of response and remedial
efforts in the event of a suspected or confirmed breach of data from this system of records.
4.

WHETHER DISCLOSURE IS MANDATORY OR VOLUNTARY AND EFFECT ON INDIVIDUAL OF NOT PROVIDING INFORMATION: It is mandatory
that you furnish the requested information pursuant to the Debt Collection Improvement Act of 1996 (Public Law 104-134). If you do not provide the
requested information, we may no longer be able to conduct business with you, and if you are due a refund, you may give up your rights to your refund.

5. SYSTEM MANAGER AND ADDRESS: Controller, Division of the Controller, Office of the Chief Financial Officer, U.S. Nuclear Regulatory Commission,
Washington, DC 20555-001.