Nrc Form 835 - Us Nuclear Regulatory Commission Office Of The Inspector General Far Contractor Reporting Form Page 3

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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
Comments
Please provide a complete description of the facts and circumstances surrounding the reported activities,
including the evidence forming the basis of this report, the names of the individuals involved, dates, location,
how the matter was discovered, potential witnesses and their involvement and any corrective action taken.
NOTE: Please provide the names, email contact, and business phone for any individuals involved and/or
potential witnesses.
Please list any other entities you are notifying:
Certification
I certify that the information contained herein is true and correct to the best of my knowledge.
Name:
Date:
I understand and acknowledge that the submission of the foregoing Contractor Disclosure Program
submission does not bar, prohibit, foreclose, or preclude the Government from pursuing any and all criminal,
civil, and/or administrative remedies provided to it by law and/or regulation against (a) the business
entity(ies) making the foregoing Contractor Disclosure Program Submission, (b) any other business entities
mentioned in the submission, and/or any individuals mentioned in the submission.
To access the Federal Acquisition Regulation click on these links:
Page 3 of 3
NRC FORM 835 (12-2012)

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