NWPA-830G Appendix G

NWPA-830G
(Revised 03/12)

U.S. DEPARTMENT OF ENERGY

OMB No. 1901-0260
Expires:

Germantown, MD 20874-1290

Appendix G -Standard Remittance Advice for Payment of Fees
This information is being collected under mandatory authorities vested in the U.S. Department of Energy under Public Law 97-425. Late filing, failure to file or otherwise comply with
instructions provided may result in interest penalties as provided by Article VIII C of the Standard Contract of Spent Nuclear Fuel and/or High Level Radioactive Waste. For information
concerning confidentiality of information see Item 6 of the instructions. Public reporting burden for this collection of information is estimated to average 5 hours per response, including
the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send
comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Survey Development and
Statistical Integration, Energy Information Administration, Washington, D.C. 20585; and to the Office of Information and Regulatory Affairs, Office of Management and Budget,
Washington, D.C. 20503. According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control
number.

1.0

IDENTIFICATION INFORMATION
1.1 Purchaser Information
(a) Name: _____________________________________________
(b) Address: ___________________________________________
(c) City, State & Zip Code: ______________________________
1.2 Contact Person
(a) Name: ____________________________________________
(b) Telephone (Include Area Code): ______________________

2.0

1.3 Standard Contract Identification Number:
__________________________________________________________

1.4 Period Covered by this Remittance Advice
(a) From ____________________
to ________________________
(Month/Day/Year)
(Month/Day/Year)
(b) Date of this Payment: ____________________________________
(Month/Day/Year)

SPENT NUCLEAR FUEL (SNF) FEE
2.1 Number of Reactors Covered:

________________________

2.6 Option Chosen:

__________________________________________

2.2 Total Purchaser Obligation as of April 7, 1983: $____________
2.3 Date of First Payment:

Month

Day

Year

2.4 10-Year Treasury Note Rate as of the Date of
First Payment - - - - - - - - - - - >
__________________%
2.5 Unpaid Balance Prior to this Payment: $_________________

3.0

FEE FOR ELECTRICITY GENERATED AND SOLD (MILLS PER KILOWATT HOUR, M/kWh)
3.1 Number of Reactors Covered:

________________________

3.2 Total Electricity Generated and Sold (Megawatt hours)
(Sum of Line 4.2 from all Annex A's):
3.3 Current Fee Rate:

4.0

2.7 Fee Data
(a) Principal: ________________________________________________
(b) Interest:_________________________________________________
(c) Total Spent Nuclear Fuel Fee:
Transmitted with this Payment
$________________________
3.4 Total Fee for Electricity Generated and Sold
(M/kWh) Transmitted with this Payment:

___________________

$ _______________________________

__________________ (M/kWh)

UNDERPAYMENT/LATE PAYMENT (As notified by DOE)
Date of Notification
(Month/Day/Year)
(b)

Type of Payment
(a)

DOE Invoice
Number
(c)

Date of Payment
Transmittal
(Month/Day/Year)
(d)

Interest Paid
(e)

Amount
Transmitted
(f)

4.1 SNF Underpayment
4.2 Electricity Generation Underpayment
4.3 TOTAL UNDERPAYMENT
4.4 SNF Late Payment
4.5 Electricity Generation Late Payment
4.6 TOTAL LATE PAYMENT

5.0

OTHER CREDITS CLAIMED (Attached Explanation)
Enter the Total Amount Claimed for All Credits

6.0

7.0

$___________________________

TOTAL REMITTANCE
6.1 Total Spent Nuclear Fuel Fee Transmitted (from 2.7(c))

$ ___________________________

6.2 Total Fee for Electricity Generated and Sold (from 3.4)
6.3 Total Underpayment (from 4.3(f))
6.4 Total Late Payment (from 4.6(f))
6.5 Total Credits (from 5.0)
6.6 TOTAL REMITTANCE (Sum of 6.1 through 6.4 minus 6.5)

$
$
$
$

___________________________
___________________________
___________________________
___________________________
$ ___________________________

CERTIFICATION

I certify that the Total Remittance is true and accurate to the best of my knowledge.
Name

Date

Signature

Title 18 USC 1001 makes it a crime for any person to knowingly and willfully make to any department or agency of the United States any false, fictitious, or
fraudulent statements as to any matter within its Jurisdiction.
Copy Distribution:

White, DOE-Controller;

Canary, DOE-EIA;

Pink, DOE-GC;

Goldenrod, Utility Copy