Nrc Form 835 - Us Nuclear Regulatory Commission Office Of The Inspector General Far Contractor Reporting Form Page 2

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NRC FORM 835
U.S. NUCLEAR REGULATORY COMMISSION
(12-2012)
U. S. NUCLEAR REGULATORY COMMISSION
OFFICE OF THE INSPECTOR GENERAL
FAR CONTRACTOR REPORTING FORM
Contract Information
DUNS Number
NRC Contract Number
NRC Contract Officer
Short Title
Description of Services/Supplies/Systems
Contract Expiration
Obligated Funds
Type of Contract
Firm Fixed Price
or Cost Reimbursable
Contract Value
List of all Federal agencies with whom you or your company are conducting business
Incident
Description of Loss
Estimated Amount of Loss
Potential Violation
Date Contractor Learned of Violation
No
Has an investigation been conducted?
Yes
Attributes
Does the incident you are reporting include any of the following attributes? (check all that apply)
Duration of the activity longer than 3 months
Multiple individuals involved
Actual or potential security compromise
Actual or potential employee/public safety/health threat
Actual or potential misuse of personally identifiable information
Actual or potential national security threat
Other (Explain in detail)
Page 2 of 3
NRC FORM 835 (12-2012)

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