Form NWPA-830G Appendix G

NWPA-830G
(Revised 03/12)

U.S. DEPARTMENT OF ENERGY

OMB No. 1901-0260
Expires: xx-xx-xxxx
Burden: 5 Hours

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:

_

2.6 Option Chosen:

Yea r

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

%

3.4 Total Fee for Electricity Generated and Sold

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

(M/kWh) Transmitted with this Payment:
$

(M/kWh)

UNDERPAYMENT/LATE PAYMENT (As notified by DOE)
Type of Payment
(a)

Date of Notification
(Month/Day/Year)
(b)

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

2.7 Fee Data
(a) Principal:
(b) Interest:
(c) Total Spent Nuclear Fuel Fee:
Transmitted with this Payment
$

FEE FOR ELECTRICITY GENERATED AND SOLD (MILLS PER KILOWATT HOUR, M/kWh) Complete Items 3.3 and 3.4 Only When Fee Rate Is Greater Than Zero
3.1 Number of Reactors Covered:

4.0

DOE Invoice
Number
(c)

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

Amount
Transmitted
(f)

$

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)

7.0

Interest Paid
(e)

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

6.0

$
$
$
$
$
$

CERTIFICATION

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

_

SPENT NUCLEAR FUEL (SNF) FEE
2.1 Number of Reactors Covered:
2.2 Total Purchaser Obligation as of April 7, 1983: $
2.3 Date of First Payment:
Month
Da y

3.0

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)

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.