OMB control number
NRC Form 176 - Security Acknowledgment and Termination Statement
OMB 3150-0239 · NRC.
OMB 3150-0239
The NRC Form 176, “Security Acknowledgment and Termination Statement” is completed by employees, licensees and contractors in connection with the termination of their access authorization/security clearance granted by the NRC and to acknowledgment and accept their continuing security responsibility.
The latest form for NRC Form 176 - Security Acknowledgment and Termination Statement expires 2028-12-31 and is listed under ICR 202511-3150-004.
Latest Forms, Documents, and Supporting Material
| Document | Type |
|---|---|
 Form NRC Form 176 Security Acknowledgement and Termination Statement | Form and Instruction |
| Form NRC Form 176 NRC Form 176, Security Acknowledgment and Termination Statement. | Form and Instruction |
 OMB 3150-0239, Final Supporting Statement for NRC Form 176, Security Acknowledgement and Termination Statement.docx | Supporting Statement A |
| OMB 3150-0239, Final Supporting Statement for NRC Form 176, Security Acknowledgement and Termination Statement.docx | Supporting Statement A |
| 2025-21311.pdf | Supplementary Document |
| Comment- NRC Form 176.docx (document unavailable) | Public Comments |
 NRC Form 176, Security Acknowledgment and Termination Statement. |
Form and Instruction |
| NRC Form 176, Security Acknowledgment and Termination Statement. |
Form and Instruction |
All Historical Document Collections
| Reference | Filing | Received | Concluded | Action |
|---|---|---|---|---|
| 202511-3150-004 | Revision of a currently approved collection | 2025-11-26 | ||
| 202208-3150-007 | Extension without change of a currently approved collection | 2022-08-19 | Approved without change | |
| 201907-3150-004 | New collection (Request for a new OMB Control Number) | 2019-07-11 | Approved with change |