Form NRC Form 531 NRC Form 531 Request for Taxpayer Identification Number

NRC FORM 531

U.S. NUCLEAR REGULATORY COMMISSION

(MM-DD-YYYY)
NRC MD 12.3

REQUEST FOR TAXPAYER
IDENTIFICATION NUMBER
*Note: Social Security Numbers must not be visible on the outside of any package sent by mail.

APPROVED BY OMB: NO. 3150-0188

EXPIRES: (MM/DD/YYYY)

Estimated burden per response to comply with this mandatory collection request: 15 minutes. The
information is required by NRC to process payments to contractors. Send comments regarding burden
estimate to the FOIA, Library, and Information Collections Branch (T-6A10M), U.S. Nuclear Regulatory
Commission, Washington, DC 20555-0001, or by email to Infocollects.Resource@nrc.gov, and the
OMB Reviewer at: OMB Office of Information and Regulatory Affairs, (3150-0188), Attn: Desk Officer
for the Nuclear Regulatory Commission, 725 17th Street NW, Washington, DC 20503. The NRC may
not conduct or sponsor, and a person is not required to respond to, a collection of information unless
the document requesting or requiring the collection displays a currently valid OMB control number.

In accordance with the Debt Collection Improvement Act of 1996, you are required to provide your
taxpayer identification number. This number may be used to make payments (refunds) or for purposes
of collecting and reporting on any delinquent amounts arising out of your relationship with the Federal
Government.
Please complete the applicable blocks and email the completed form to Fees_Regions@nrc.gov.
OPTIONAL: Instructions to send a password protected pdf can be found at the end of this form.
Thank you for your assistance and cooperation. If you have any questions, please contact us. Our
telephone number is (301) 415-7554.
Indicate the status of your business:
CORPORATION

OTHER (Specify in box below)

CITY/STATE GOVERNMENT
INDIVIDUAL

PARTNERSHIP

FEDERAL GOVERNMENT

TAXPAYER IDENTIFICATION NUMBER
SOCIAL SECURITY NUMBER

-

NRC LICENSE OR
REGISTRATION NUMBER(S)

-

OR
EMPLOYER IDENTIFICATION NUMBER

-

Under penalties of perjury, I certify that the number shown on this form is my correct
taxpayer identification number.
SIGNATURE - TAXPAYER REPRESENTATIVE

NRC LICENSEE OR VENDOR

BILLING ADDRESS

BILLING TELEPHONE NUMBER

NRC Form 531 (MM-DD-YYYY)

BILLING EMAIL ADDRESS

PRIVACY ACT STATEMENT
NRC FORM 531
REQUEST FOR TAXPAYER IDENTIFICATION NUMBER
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 (NRC) on NRC Form 531.
This information is maintained in a system of records designated as NRC-32 and described at 84 Federal Register 71559
(December 27, 2019), or the most recent Federal Register publication of the NRC's Systems of Records Notices that is
located in the NRC's Agencywide Documents Access and Management System (ADAMS).
1. AUTHORITY: U.S.C. 552a; 5 U.S.C. 5514; 15 U.S.C. 1681; 26 U.S.C. 6103; 31 U.S.C. chapter 37; 31 U.S.C. 6501 -6508;
42 U.S.C. 2201; 42 U.S.C. 5841; 31 CFR 900 -904; 10 CFR parts 15, 16, 170, 171; Executive Order (E.O.) 9397, as
amended by E.O. 13478; and E.O. 12731.
2. PURPOSE(S): To obtain taxpayer identification number/social security number/individual taxpayer identification number
to enable the NRC to process payments and collect/report delinquent debts.
3. ROUTINE USES: Information from this form may be transmitted to: debt collection contractors and/or Federal agencies
for collecting delinquent debts and/or collection action on such debts; any Federal, State or local agencies to conduct
authorized computer matching programs and to credit reporting agencies; Treasury on past due non-tax debts for the
purpose of locating the debtor and/or effecting offset under Treasury Offset Program. Information may be publicly
disseminated regarding the identity of delinquent non-tax debtors and the existence of non-tax debts under the provisions of
the Debt Collection Improvement Act of 1996. Information may be disclosed in accordance with any of the Routine Uses
listed in the Prefatory Statement of General Routine Uses, including to an appropriate Federal, State, local or Foreign agency
in the event the information indicates a violation or potential violation of law; in the course of an administrative or judicial
proceeding; to an appropriate Federal, State, local and foreign agency to the extent relevant and necessary for an NRC
decision about you or to the extent relevant and necessary for that agency's decision about you; in the course of discovery
under a protective order issued by a court of competent jurisdiction, and in presenting evidence; to a Congressional office to
respond to their inquiry made at your request; to NRC-paid experts, consultants, and others under contract with the NRC, on
a need-to-know basis; or to appropriate persons and entities for purposes of response and remedial efforts in the event of a
suspected or confirmed breach of data from this system of records.
4. WHETHER DISCLOSURE IS MANDATORY OR VOLUNTARY AND EFFECT ON INDIVIDUAL OF NOT PROVIDING
INFORMATION: It is mandatory that you furnish the requested information pursuant to the Debt Collection Improvement Act
of 1996 (Public Law 104-134). If you do not provide the requested information, we may no longer be able to conduct
business with you, and if you are due a refund, you may give up your rights to your refund.
5. SYSTEM MANAGER AND ADDRESS: Comptroller, Division of the Comptroller, Office of the Chief Financial Officer, U.S.
Nuclear Regulatory Commission, Washington, DC 20555-001.
PLEASE PROTECT YOUR SENSITIVE DATA BY ENCRYPTION BEFORE TRANSMITTING VIA EMAIL
Instructions for adding a password to a PDF
1. Open the PDF and choose FILE > PROPERTIES
2. Click on SECURITY > PASSWORD SECURITY > OK
3. Check mark the box under DOCUMENT OPEN
4. In DOCUMENT OPEN PASSWORD enter in the password you created for this document
5. Under the options box go to the COMPATIBILITY field and select Acrobat X and later from the drop_down box
6. Click on OK
7. A box will display requesting you to Confirm the DOCUMENT OPEN PASSWORD, type in the password again
in the field
8. Click on OK
9. A notification will display confirming action and requesting to save the document so that the new changes will
be saved
10. Click on the SAVE icon from the pdf menu toolbar to save the document
11. Please send the password for the protected file/s in a separate email to Fees_Regions@nrc.gov referencing
your Docket number in the email subject field