Form NRC Form 531 NRC Form 531 Request for Taxpayer Indentification Number

NRC FORM 531

U.S. NUCLEAR REGULATORY COMMISSION

(MM-YYYY)
NRC MD 12.3

REQUEST FOR TAXPAYER
IDENTIFICATION NUMBER

APPROVED BY OMB: NO. 3150-0188

EXPIRES: (MM/DD/YYYY)

Estimated burden per response to comply with this mandatory collection request: 15 minutes. The
information is required by NRC to process payments to contractors. Send comments regarding burden
estimate to the Information Services Branch (T-2F43), U.S. Nuclear Regulatory Commission,
Washington, DC 20555-0001, or by 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.

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) 415-4135. 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

OTHER (Specify in box below)

CITY/STATE GOVERNMENT
INDIVIDUAL

PARTNERSHIP

FEDERAL GOVERNMENT

TAXPAYER IDENTIFICATION NUMBER

SOCIAL SECURITY NUMBER

-

NRC LICENSE OR
REGISTRATION NUMBER(S)

-

OR
EMPLOYER IDENTIFICATION NUMBER

-

Under penalties of perjury, I certify that the number shown on this form is my correct
taxpayer identification number.
SIGNATURE - TAXPAYER REPRESENTATIVE

NRC LICENSEE OR VENDOR

BILLING ADDRESS

BILLING TELEPHONE NUMBER

NRC Form 531 (MM-YYYY)

BILLING EMAIL ADDRESS

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PRIVACY ACT STATEMENT
NRC FORM 531
REQUEST FOR TAXPAYER IDENTIFICATION NUMBER
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 81 Federal Register 81342 (November 17, 2016), or the most recent Federal Register publication of
the NRC's Systems of Records Notices that is located in the NRC's Agencywide Documents Access and
Management System (ADAMS).
1. AUTHORITY: 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.

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