NWPA-830G Appendix G

NWPA-830G	U.S. DEPARTMENT OF ENERGY	OMB No. 1901-0260
	Germantown, MD 20874-1290	Expires: xx-xx-xxxx Burden: 5 Hours

^{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 42 U.S.C. §10101. 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 (OMB), 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 1.3 Standard Contract Identification Number: (a) Name:

(b) Address:

(c) City, State & Zip Code:

1.2 Contact Person 1.4 Period Covered by this Remittance Advice

(a) Name:

(a) From

to _

(b) Telephone (Include Area Code): _ (Month/Day/Year) (Month/Day/Year)

(b) Date of this Payment: (Month/Day/Year)

2.0 SPENT NUCLEAR FUEL (SNF) FEE

2.1 Number of Reactors Covered:

2.2 Total Purchaser Obligation as of April 7, 1983: $

Month		Da y		Yea r

2.3 Date of First Payment:

2.6 Option Chosen:

2.7 Fee Data

(a) Principal:

2.4 10-Year Treasury Note Rate as of the Date of (b) Interest:

First Payment - - - - - - - - - - - >

% (c) Total Spent Nuclear Fuel Fee

2.5 Unpaid Balance Prior to this Payment: $

Transmitted with this Payment:

$

3.0 FEE FOR ELECTRICITY GENERATED AND SOLD (MILLS PER KILOWATT HOUR, M/kWh)

3.1 Number of Reactors Covered:

3.4 Total Fee for Electricity Generated and Sold

3.2 Total Electricity Generated and Sold (Megawatt hours) (M/kWh) Transmitted with this Payment:

(Sum of Line 4.2 from all Annex A's): $

3.3 Current Fee Rate: (M/kWh)

4.0 UNDERPAYMENT/LATE PAYMENT (As notified by DOE)

	Type of Payment (a)	Date of Notification (Month/Day/Year) (b)	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	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	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.