Nrc Form 850a - Request For Nrc Contractor Building Access Authorization
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202/12/2013
PRIVACY ACT STATEMENT
NRC FORM 850A
Request for NRC Contractor Building Access Authorization
Pursuant to 5 U.S.C. 552a(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 on NRC Form 850A. This information is maintained in a system of records
designated as NRC-39, described at 77 Federal Register 67231 (November 8, 2012), or the most recent
Federal Register publication of the Nuclear Regulatory Commission's "Republication of Systems of
Records Notices" that is located in 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.; Executive Order (E.O.) 9397, as amended by E.O. 13478; E.O. 10450, as
amended; E.O. 10865, as amended; E.O. 12958, amended by E.O. 13256; E.O. 13467; E.O.
13526; 10 CFR Parts 10, 11, 14, 25, 50, 73, 95; OMB Circular No. A-130, Revised; 5 CFR 731,
732, and authorities cited therein.
2.
PRINCIPAL PURPOSE(S): To obtain necessary building access authorization for NRC
contractors, subcontractors, or other individuals who are not applicants for employment with
NRC.
3.
ROUTINE USE(S): Information in these records may be used by the Division of Facilities and
Security and on a need-to-know basis by appropriate NRC officials, Hearing Examiners,
Personnel Security Review Panel members, Office of Personnel Management, Central
Intelligence Agency, and other Federal agencies: a. To determine clearance or access
authorization eligibility; b. To determine eligibility for access to NRC buildings or access to
Federal automated information systems or data; c. To certify clearance or access authorization;
d. To maintain the NRC personnel security program; e. To provide licensees information needed
for unescorted access or access to safeguard information determinations; and f. For any of the
routine uses specified in the Prefatory Statement of General Routine Uses.
WHETHER DISCLOSURE IS MANDATORY OR VOLUNTARY AND EFFECT ON INDIVIDUAL
4.
Disclosing this information is voluntary; however,
OF NOT PROVIDING INFORMATION:
not providing the requested information your access authorization or clearance request
cannot be processed.
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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