View Information Collection Request (ICR) Package

Please note that the OMB number and expiration date may not have been determined when this Information Collection Request and associated Information Collection forms were submitted to OMB. The approved OMB number and expiration date may be found by clicking on the Notice of Action link below.

View ICR - OIRA Conclusion

OMB Control No: 3150-0239	ICR Reference No: 202511-3150-004
Status: Active	Previous ICR Reference No: 202208-3150-007
Agency/Subagency: NRC	Agency Tracking No:
Title: NRC Form 176 - Security Acknowledgment and Termination Statement
Type of Information Collection: Revision of a currently approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 12/29/2025
Retrieve Notice of Action (NOA)	Date Received in OIRA: 11/26/2025
Terms of Clearance: In accordance with 5 CFR 1320, the information collection is approved for three years. OMB reminds the Agency, however, it should consult with up to 9 outside entities at least once every 3 years even if the collection of information has not changed.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2028	36 Months From Approved	12/31/2025
Responses	1,000	0	400
Time Burden (Hours)	200	0	80
Cost Burden (Dollars)	0	0	0

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Adjustment in Estimate
Annual Number of Responses	1,000	400	600
Annual Time Burden (Hours)	200	80	120
Annual Cost Burden (Dollars)	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: NRC Form 176 has added “Controlled Unclassified Information” to the form which increases the number of future users that will need to sign the form before gaining access to sensitive non-classified information. The NRC modified the form to include a print name field in addition to the signature field for clarity. There is no change in the burden required to complete the form. In response to a comment received from the 60-day comment period, the NRC Form 176A #10 was changed to match the language of the MD 12.3. The responses increased from 400 responses to 1,000 responses (an increase of 600 responses) and the total burden has increased from 80 hours to 200 hours (an increase of 120 hours). The cost has increased due to a change in the fee rate from $288 per hour to $317 per hour.

Annual Cost to Federal Government: $63,453

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination. No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination. No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

Agency Contact: Lisa Nichols-Streck 301 415-5834