Form NRC Form 754 NRC Form 754 ARMED SECURITY PERSONNEL FIREARMS BACKGROUND CHECK

NRC FORM 754

U.S. NUCLEAR REGULATORY COMMISSION

(MM-YYYY)

ARMED SECURITY PERSONNEL
FIREARMS BACKGROUND CHECK
*Note: Social Security Numbers must not be visible on the outside of any package sent by mail.

NICS Transaction Number (NTN)

APPROVED BY OMB: NO. 3150-XXXX

EXPIRES: (MM/DD/YYYY)

Estimated burden per response to comply with this mandatory information collection request: 2.2
hours. NRC uses the information to verify that personnel protecting NRC-regulated entities are not
prohibited from receiving, possessing, transporting, importing, or using covered weapons as part of
the performance of their official duties. Send comments regarding burden estimate to the FOIA,
Library, and Information Collections Branch (T-6 A10M), U.S. Nuclear Regulatory Commission,
Washington, DC 20555-0001, or by e-mail to [email protected],and the OMB
reviewer at: OMB Office of Information and Regulatory Affairs, (3150-0204), Attn: Desk Officer for
the Nuclear Regulatory Commission, 725 17th Street NW, Washington, DC 20503; e-mail:
[email protected]. The NRC may not conduct or sponsor, and a person is not
required to respond to, a collection of information unless the document requesting or requiring the
collection displays a currently valid OMB control number.

Warning: Security personnel protecting NRC designated facilities, radioactive material, or other property are not authorized
to receive, possess, transport, import, or use firearms pursuant to § 161A of The Atomic Energy Act of 1954, as amended,
42 U.S.C. § 2201a, if prohibited under Federal or State law. The information you provide will be used to verify that you are
not prohibited under Federal or State law from receiving, possessing, transporting, importing, or using any firearms.
Prepare in original only. Must be completed personally by individual. All entries must be in ink. Please type or print all
information. Read the Important Notices, Instructions, and Definitions on this form.
1. Individual's Full Name (Last, First, Middle) (If no middle name state "NMN")

2. Other Previously Used Names (e.g., Maiden) (Last, First, or Middle)

3. Current Residence Address (Cannot be a post office box) (U.S. Postal abbreviations are acceptable) (See Instruction 3)
Number and Street Address

City

County

State

Zip Code

4. Current Duty Station Location(s). (Use U.S. Postal abbreviations for the State or Territory) (See Instruction 4)

5. Place of Birth
U.S. City/State

6. Height
- or -

Foreign Country

Ft.

7. Weight
In.

lb.

8. Gender

9. Birth Date (MM/DD/YYYY)

Male
Female

10. Social Security Number (Enter 9 numeric digits)

11. Unique Personal Identification Number (UPIN), if applicable (See Instruction 5)

12. Race (Ethnicity) (Check one or more boxes) (See Instruction 6)

American Indian or Alaska Native

Black or African American

Native Hawaiian or Other Pacific Islander

Hispanic or Latino

Asian

White

13. What is your country of citizenship? (List/check more than one, if applicable)

United States of America

Other (Specify):

14. If you are not a citizen of the United States, what is your U.S. issued alien number or admission number?

15. If you are a nonimmigrant alien, what exception do you fall under as described in Important Notice 3, Exception 2? (Specify the documentation showing an
exemption to the nonimmigrant alien prohibition)

I certify that the answers above are true and correct. I have read and understand the Important Notices, Instructions, and
Definitions for this form. I understand that making any false oral or written statement is a crime punishable as a felony.
16. Security Personnel's Signature

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17. Certification Date (MM/DD/YYYY)

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ARMED SECURITY PERSONNEL FIREARMS BACKGROUND CHECK (Continued)
Important Notices
1. Purpose of the Form: The information and certification on this
form are designed to support a verification that security personnel
protecting U.S. Nuclear Regulatory Commission (NRC) designated
facilities, radioactive material, or other property are not prohibited
from receiving, possessing, transporting, or using firearms as part
of the performance of their official duties under § 161A of the
Atomic Energy Act of 1954, as amended (AEA), 42 U.S.C. §
2201a. Submission of this form is mandatory for security
personnel of license holders who apply to the NRC for Section
161A. authority. Failure to submit this form will result in the
individual being denied access to firearms as part of their official
security duties at NRC-regulated entities.
Evaluation of the information contained in this form will permit the
NRC to verify that individuals who are prohibited from possessing
or receiving any firearms under Federal or State law do not
possess or receive firearms (including enhanced weapons) as part
of their current or proposed official duties as security personnel.
This determination is required of all security personnel protecting
NRC designated facilities, radioactive material, or other property.
2. Background Checks: Section 161A requires that security
personnel receiving, possessing, transporting, or using a covered
weapon shall be subject to a background check by the Attorney
General, based on fingerprints and including a background check
under section 103(b) of the Brady Handgun Violence Prevention
Act (Brady Act), Public Law 103-159, 18 U.S.C. § 922(t), to
determine whether the person is prohibited from possessing or
receiving firearms under Federal or State law. The Brady Act
provides for the submission of information to the Federal Bureau of
Investigation's (FBI's) National Instant Criminal Background Check
Systems (NICS) to verify that an individual is not prohibited under
Federal or State law from possessing or receiving firearms.
3. Prohibited Persons: Generally, 18 U.S.C. § 922 prohibits the
shipment, transportation, receipt, or possession in or affecting
interstate commerce of firearms by anyone who: (1) has been
convicted of a misdemeanor crime of domestic violence; (2) has
been convicted of a felony, or any other crime, punishable by
imprisonment for a term exceeding one year (this does not include
State misdemeanors punishable by imprisonment of two years or
less); (3) is a fugitive from justice; (4) is an unlawful user of, or
addicted to, marijuana or any depressant, stimulant, or narcotic
drug, or any controlled substance; (5) has been adjudicated
mentally defective or has been committed to a mental institution;
(6) has been discharged from the Armed Forces under
dishonorable conditions; (7) has renounced his or her U.S.
citizenship; (8) is an alien illegally in the United States or a
nonimmigrant alien; or (9) is subject to certain restraining orders.
Furthermore, § 922 prohibits the shipment, transportation, or
receipt of firearms to anyone who is under an indictment or
information in any court for a felony, or any other crime, punishable
by imprisonment for a term exceeding one year.
Exception 1: A person who has been convicted of a felony, or any
other crime, for which the judge could have imprisoned the person
for more than one year, or has been convicted of a misdemeanor
crime of domestic violence, is not prohibited from receiving,
possessing, transporting, importing, or using covered weapons if:
(1) under the law of the jurisdiction where the conviction occurred,
the person has been pardoned, the conviction has been expunged
or set aside, or the person has had certain civil rights (the right to
vote, sit on a jury, and hold public office) restored AND (2) the
person is not prohibited by the law of jurisdiction where the
conviction occurred from receiving or possessing firearms.
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A person who has been convicted of a misdemeanor crime of
domestic violence also is not prohibited unless: (1) the individual
was represented by a lawyer or gave up the right to a lawyer; and
(2) if the person was entitled to a jury, was tried by a jury, or gave
up the right to a jury trial.
Exception 2: A nonimmigrant alien is not prohibited from
possessing or receiving a covered weapon as part of their official
duties at NRC regulated facilities if the alien: (1) meets the
exceptions of 18 U.S.C. § 922(y)(2)(B), (y)(2)(C), or (y)(2)(D); or
(2) has received a waiver from the Attorney General of the United
States (See 18 U.S.C. § 922(y)(3) for additional information on
waivers.)
4. Restraining Order: Under 18 U.S.C. § 922, firearms may not be
possessed or received by persons subject to a court order that:
(1) was issued after a hearing which the person received actual
notice of and had an opportunity to participate in; (2) restrains
such person from harassing, stalking, or threatening an intimate
partner or child of such intimate partner or person, or engaging in
other conduct that would place an intimate partner in reasonable
fear of bodily injury to the partner or child; and (3)(i) includes a
finding that such person represents a credible threat to the
physical safety of such intimate partner or child; or (ii) by its terms
explicitly prohibits the use, anticipated use, or threatened use of
physical force against such intimate partner or child that would
reasonably be expected to cause bodily injury.
5. NICS Responses: The FBI will provide a "proceed," "delayed," or
"denied" NICS response and a NICS transaction number to the
NRC that will be forwarded to you via your submitting license
holders.

Instructions to Security Personnel
1. Individuals must personally complete this form and certify (sign)
that the information on this form is true and correct.
2. If the individual is a member of the Armed Forces on active duty
and is receiving, possessing, transporting, or using covered
weapons in the State where his or her permanent duty station is
located, but does not reside at his or her permanent duty station,
the security personnel must list his or her permanent duty station
address in the response to question 4 and his or her residence
address in response to question 3.
3. Current Residence Address: If you are a U.S. citizen with two
States of residence, you should list your current residence address.
4. Duty Station Location(s): Enter the U.S. Postal abbreviation for
the State or Territory for the duty station location. Multiple States
or Territories may be entered for multiple duty stations. For
personnel escorting shipments of radioactive material or other
property, enter the State or Territory affected by the shipment or
enter "CONUS."
5. Unique Personal Identification Number (UPIN): If you have a
UPIN issued to you by the FBI's NICS Voluntary Appeal File
(based upon previous firearms transactions or based upon
previous firearms security background checks), you should enter
the UPIN under question 11. Entry of a UPIN is voluntary.
However, failure to provide your issued UPIN may result in a
"delayed" or "denied" NICS response.
6. Race (Ethnicity): For any other race or ethnicity that does not fall
within the indicated categories, please select the closest
representation.
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ARMED SECURITY PERSONNEL FIREARMS BACKGROUND CHECK (Continued)
Definitions
1. Under indictment or information or conviction in any court:
An indictment, information, or conviction in Federal, State, or local
court.
2. Misdemeanor Crime of Domestic Violence: A Federal, State, or
local offense that is a misdemeanor under Federal or State law and
has, as an element, the use or attempted use of physical force, or
the threatened use of a deadly weapon, committed by a current or
former spouse, parent, or guardian of the victim, by a person with
whom the victim shares a child in common, by a person who is
cohabiting with, or has cohabited with the victim as a spouse,
parent, or guardian, or by a person similarly situated to a spouse,
parent, or guardian of the victim. The term includes all
misdemeanors that have as an element the use or attempted use
of physical force or the threatened use of a deadly weapon (e.g.,
assault and battery), if the offense is committed by one of the
defined parties.
3. Intimate Partner: An "intimate partner" of a person is: the spouse
or former spouse of the person, the parent of a child of the person,
or an individual who cohabits or has cohabited with the person.
4. State of Residence: The State in which an individual resides. An
individual resides in a State if he or she is present in a State with
the intention of making a home in that State. If an individual is a
member of the Armed Forces on active duty, his or her State of
residence also is the State in which his or her permanent duty
station is located. An alien who is legally in the United States is a
resident of a State only if the alien is residing in the State and has
resided in the State continuously for at least 90 days immediately
prior to the date of submission of this form.
5. Nonimmigrant Alien: An alien in the United States in a
nonimmigrant classification. The definition includes, in large part,
persons traveling temporarily in the United States for business or
pleasure, persons studying in the United States who maintain a
residence abroad, and certain foreign workers. The definition does
NOT include permanent resident aliens.
6. Unique Personal Identification Number (UPIN): For individuals
approved to have information maintained about them in FBI's NICS
Voluntary Appeal File (VAF), NICS will provide them with a UPIN
for their use in future firearms transactions or firearms background
checks under § 161A of the AEA.

7. Covered Weapon: Covered weapon means any handgun, rifle,
shotgun, short-barreled shotgun, short-barreled rifle, semiautomatic assault weapon, machine gun, ammunition for any such
weapon, or large capacity ammunition feeding device as specified
under section 161A. The terms "handgun, rifle, shotgun, shortbarreled shotgun, short-barreled rifle, semi-automatic assault
weapon, machine gun, ammunition, and large capacity ammunition
feeding device" have the same meaning provided for these terms
in 18 U.S.C. § 921(a).

PRIVACY ACT STATEMENT
NRC FORM 754, ARMED SECURITY PERSONNEL FIREARMS
BACKGROUND CHECK
Pursuant to 5 U.S.C. 552(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 754.
This information is maintained in a system of records designated
as NRC-39, described at 84 Federal Register 71568 (December
27, 2019), or the most recent Federal Register publication of the
NRC's "Republication of Systems of Records Notices" that is
located in the NRC's Agencywide Documents Access and
Management System (ADAMS).
1. AUTHORITY: 42 U.S.C. 2011 et seq.; 42 U.S.C. 2165,
2201(i), 2201a, and 2284; 42 U.S.C. 5801 et seq.; Social
Security Number Fraud Prevention Act of 2017, 42 U.S.C. 405
note; Executive Order (E.O.) 9397, as amended by E.O. 13478;
E.O. 10450, as amended; E.O. 10865, as amended; E.O. 13467;
E.O. 13526; E.O. 13587; 10 CFR parts 10, 11, 14, 25, 50, 73, 95;
OMB Circular No. A-130, Revised; 5 CFR parts 731, 732, and
authorities cited therein.
2. PRINCIPAL PURPOSE(S): This form is used to perform a
background check to verify that an individual is not prohibited
from receiving, possessing, transporting, importing, or using
covered weapons as part of the performance of their official
duties.
3. ROUTINE USE(S): This information will be used to determine
eligibility to receive, possess, transport, or import covered
weapons. 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
and in the course of an administrative or judicial proceeding. In
addition, this information may be transferred to an appropriate
Federal, State, local and foreign agency to the extent relevant
and necessary for it to carry out its responsibilities under 161A of
the Atomic Energy Act of 1954, as amended. Information may
also be disclosed, 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, or to NRC-paid experts,
consultants, and others under contract with the NRC, on a needto-know basis.
4. WHETHER DISCLOSURE IS MANDATORY OR
VOLUNTARY AND EFFECT ON INDIVIDUAL OF NOT
PROVIDING INFORMATION: Disclosing this information is
mandatory for security personnel of licensees and certificate
holders who apply to the NRC for authority to possess covered
weapons under section 161A of the Atomic Energy Act of 1954,
as amended. Failure to submit a completed form will result in the
individual being denied access to any covered weapons as part
of their official security duties at NRC-regulated entities. The
social security number is required to verify the individual's
identity to facilitate the background check requirements.
5. SYSTEM MANAGER(S) AND ADDRESS: Director, Division
of Facilities and Security, Office of Administration, U.S. Nuclear
Regulatory Commission, Washington, DC 20555-0001.

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