446 Request for Approval of International Travel by Non-Gove

U.S. NUCLEAR REGULATORY COMMISSION

NRC FORM 446

(MM-YYYY)
NRC MD 14.1

REQUEST FOR APPROVAL OF
OFFICIAL FOREIGN TRAVEL BY
NON-GOVERNMENT PERSONNEL
(*Must be completed 30 Days Prior to Travel)

APPROVED BY OMB: NO. 3150-XXXX

EXPIRES: (MM/DD/YYYY)

Estimated burden per response to comply with this voluntary collection request: 2 hours. NRC uses this form to
authorize foreign travel for non-Federal personnel in the course of conducting business for the NRC. Send comments
regarding burden estimate to the Information Services Branch (T-6 A10M), 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-XXXX), 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 .

A. TRAVELER INFORMATION (To be completed by traveler)
Name of Traveler

Name of Employer

Country of Travel

Departure Date (MM/DD/YYYY)

Return Date (MM/DD/YYYY)

Signature of Traveler

Signature Date (MM/DD/YYYY)

Purpose of Travel (Please provide a brief description of the purpose for your travel. Please spell out all acronyms.)

List of Persons with whom travel has been coordinated
NAME (i.e., Contracting Officer's Representative,
OIP Desk Officer, and other travelers)

AGENCY/OFFICE

B. REVIEW AND APPROVAL
Name of Contracting Officer's Representative (COR)

Signature of Contracting Officer's Representative

Signature Date (MM/DD/YYYY)

Deputy Director of Office of International Programs

Signature of Deputy Director of Office of International Programs

Signature Date (MM/DD/YYYY)

NRC FORM 446 (MM-YYYY)

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U.S. NUCLEAR REGULATORY COMMISSION

NRC FORM 446
(MM-YYYY)

REQUEST FOR APPROVAL OF OFFICIAL FOREIGN TRAVEL
BY NON-GOVERNMENT PERSONNEL (Continued)
(*Must be completed 30 days prior to travel)
C. TRAVEL ITINERARY

Dates

NRC FORM 446 (MM-YYYY)

Location
(City, Country)

Contact on Site
(Name, telephone number, and e-mail address)

Activity

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NRC FORM 446
(MM-YYYY)

U.S. NUCLEAR REGULATORY COMMISSION

REQUEST FOR APPROVAL OF OFFICIAL FOREIGN TRAVEL
BY NON-GOVERNMENT PERSONNEL (Continued)
(*Must be completed 30 days prior to travel)
PRIVACY ACT STATEMENT
NRC FORM 446
REQUEST FOR APPROVAL OF OFFICIAL FOREIGN TRAVEL
BY NON-GOVERNMENT PERSONNEL

Pursuant to 5 U.S.C. 552a(e)(3), enacted into law by Section 3 of the Privacy Act of 1974 (Public Law 93-570), the following
statement is furnished to individuals who supply information to the U.S. Nuclear Regulatory Commission (NRC) on NRC Form
446. This information is maintained in a system of records designated as NRC-20 and described at 81 Federal Register
81334-81335 (November 17, 2016), or the most recent Federal Register publication of the NRC's “Republication of Systems of
Records Notices” located in the NRC's Agencywide Documents Access and Management System (ADAMS).
1. AUTHORITY: 5 U.S.C. Part III, Subpart D, Chapter 57; 31 U.S.C. 716; 41 U.S.C. Subtitle II, Chapter 61; 41 CFR 102-118;
Executive Order (E.O.) 9397, as amended by E.O. 13478.
2. PRINCIPAL PURPOSE(S): To secure the required NRC approval for official foreign travel by contractor staff.
3. ROUTINE USE(S): In addition to the disclosures permitted under subsection (b) of the Privacy Act, the NRC may disclose
information from this system of records to the U.S. Treasury for payment; the Department of State or an embassy for passports
or visas; the General Services Administration and the Office of Management and Budget for required periodic reporting. The
information may also be disclosed 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; and 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:
Disclosure is voluntary, however, if the requested information is not provided, approval for foreign travel may be denied.
5. SYSTEM MANAGER AND ADDRESS: Chief, International Operations Branch, Office of International Programs, U.S. Nuclear Regulatory
Commission, Washington, DC 20555-0001.

NRC FORM 446 (MM-YYYY)

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