Nrc Form 525 - Nrc Form 525

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This form serves as a certification used to identify a small entity, and is exempt from Office of Management and Budget clearance. 5 C.F.R. 1320.3(h)(1).
NRC FORM 526
U.S. NUCLEAR REGULATORY COMMISSION
(08-2017)
CERTIFICATION OF SMALL ENTITY STATUS FOR THE PURPOSES OF
10 CFR 171
ANNUAL FEES IMPOSED UNDER 10 CFR PART 171
(Effective August 29, 2017)
If you have QUESTIONS, e-mail them to:
SmallEntity.Resource@nrc.gov
SEE IMPORTANT INSTRUCTIONS FOR NRC FORM 526 -- PLEASE READ CAREFULLY
DO NOT COMPLETE OR RETURN THIS FORM IF YOU DO NOT QUALIFY AS A SMALL ENTITY
A Licensee that is a subsidiary of a large entity, including foreign entities, does NOT qualify as a small entity.
INVOICE NUMBER
BUSINESS TELEPHONE NUMBER
NAME AND ADDRESS OF LICENSEE (as it appears on the invoice):
DOCKET NUMBER
CONTACT NAME
EMAIL ADDRESS
CONTACT TELEPHONE NUMBER
COMPANY WEBSITE ADDRESS
www.
SIZE STANDARDS
MAXIMUM ANNUAL FEE
PER LICENSED CATEGORY
(Check only 1 box below).
(See Items 2 and 3 on back)
1. SMALL BUSINESS
A for-profit concern that is not engaged in manufacturing
A. $485,000 TO $7,000,000
$ 4,100
with average GROSS receipts of $7.0 million or less over its
last 3 completed fiscal years. For further information see
$
850
B. LESS THAN $485,000
1a and 1b of attached instructions.
2. MANUFACTURING INDUSTRY
$ 4,100
A. 35 to 500 EMPLOYEES
A manufacturing concern with an average number of 500
or fewer employees based upon employment during each
$
850
B. LESS THAN 35 EMPLOYEES
pay period for the preceding 12 calendar months.
NAICS BUSINESS CODE (See 1b and 1e of attached instructions):
3. SMALL ORGANIZATION
$ 4,100
A. $485,000 TO $7,000,000
A not-for-profit organization that is independently owned and
operated and has annual GROSS receipts of $7.0 million or
B. LESS THAN $485,000
$
850
less. For further information see 1a and 1b of attached
instructions.
4. SMALL GOVERNMENTAL JURISDICTION (INCLUDING
A. 20,000 TO 49,999 POPULATION
PUBLICLY SUPPORTED EDUCATIONAL INSTITUTIONS)
$ 4,100
OF JURISDICTION
A government of a city, county, town, township, village,
B. LESS THAN 20,000 POPULATION
school district, or special district with a population of less than
$
850
OF JURISDICTION
50,000. For further information see 1f of attached instructions.
5. SMALL EDUCATIONAL INSTITUTION THAT IS NOT
$ 4,100
STATE OR PUBLICLY SUPPORTED
A. 35 to 500 EMPLOYEES
Only applicable to such small educational institutions if
$
850
B. LESS THAN 35 EMPLOYEES
they have 500 or less employees. For further information
see 1b and 1f of attached instructions.
CERTIFICATION
This certification MUST be signed by the owner of the entity named above or an official empowered to act on behalf of the entity.
I certify that the above named NRC licensee qualifies as a small entity under the size standards established by the NRC for its
licensees in 10 CFR 2.810. The licensee qualifies as a small entity under the specific size standard indicated above.
WARNING:
18 U.S.C. Section 1001, Act of June 25, 1948, 62 Stat. 749, makes it a criminal offense to make a willfully false
statement or representation to any Department or Agency of the United States as to any matter within its jurisdiction.
The submittal of willful false statements is punishable by fine or imprisonment, or both, and for purposes of this
certification, may result in revocation or suspension of the license.
TYPED OR PRINTED NAME AND TITLE
SIGNATURE
DATE
I CERTIFY UNDER PENALTY OF
PERJURY THAT THE FOREGOING
IS TRUE AND CORRECT.
NRC FORM 526 (08-2017)
See Attached Instructions

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