Information Collection

NRC Forms 850A, 850B, and 850C

IC 209500 under ICR 201308-3150-004 · OMB 3150-0218.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3150-0218 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form NRC Form 850C NRC Forms 850A, 850B, and 850C	Form and Instruction
NRC Form 850A Request for NRC Contractor Building Access Authorization NRC 850A REVISED.pdf	Form and Instruction
NRC Form 850B Request for NRC Contractor Information Technology Access NRC 850B REVISED.pdf	Form and Instruction
NRC Form 850C Request for NRC Contractor Security Clearance NRC 850C REVISED.pdf	Form and Instruction

IC Title:

NRC Forms 850A, 850B, and 850C

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	NRC Form 850C	Request for NRC Contractor Security Clearance	NRC 850C REVISED.pdf	Yes	No	Fillable Printable
Form and Instruction	NRC Form 850A	Request for NRC Contractor Building Access Authorization	NRC 850A REVISED.pdf	Yes	No	Fillable Printable
Form and Instruction	NRC Form 850B	Request for NRC Contractor Information Technology Access Authorization	NRC 850B REVISED.pdf	Yes	No	Fillable Printable

Line of Business: General Government

Subfunction: Central Personnel

Privacy Act System of Records

Title: NRC-39, Personnel Security Records and Associated Files

FR Citation: 77 FR 67231

Number of Respondents: 500

Number of Respondents for Small Entity: 230

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	500	500
Annual IC Time Burden (Hours)	85	85
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.