Form NRC Form 790 NRC Form 790 Classfication Record

(MM-YYYY)

EXPIRES: (MM/DD/YYYY)

APPROVED BY OMB: NO. 3150-0052

U.S. NUCLEAR REGULATORY COMMISSION

NRC FORM 790

Estimated burden per response to comply with this mandatory information collection request: 6 minutes. This
submittal is required by NRC to report classification or declassification of documents in accordance with Executive
Order 13526. Send comments regarding burden estimate to the Information Services Branch (T-2 F43), U.S. Nuclear
Regulatory Commission, Washington, DC 20555-0001, or by e-mail to Infocollects.Resource@nrc.gov, and to the
Desk Officer, Office of Information and Regulatory Affairs, NEOB-10202, (3150-0052), Office of Management and
Budget, Washington, DC 20503. If a means used to impose an information collection does not display a currently
valid OMB control number, the NRC may not conduct or sponsor, and a person is not required to respond to, the
information collection.

CLASSIFICATION RECORD
Authorized classifiers MUST COMPLETE THIS FORM for each
classification or declassification review performed. Enter
only the number of characters required in each space.

SECTION A - TO BE COMPLETED FOR ALL CLASSIFICATION ACTIONS
1. AUTHORIZED CLASSIFIER'S NAME (Last, First, M.I)

2. AUTHORIZED CLASSIFIER'S NUMBER

3. FORM COMPLETION DATE (MM/DD/YYYY)

4. DOCUMENT TITLE

5. FACILITY/OFFICE SYMBOL

6. DOCUMENT DATE (MM/DD/YYYY)

7. TYPE OF ACTION

8. OVERALL CLASSIFICATION CODE

Select Type of Action

Select Overall Classification Code

SECTION B - TO BE COMPLETED FOR ORIGINAL CLASSIFICATION ACTIONS
9. REASON FOR CLASSIFICATION (Select all that apply)

10. DECLASSIFICATION INSTRUCTION

(a) military plans, weapons systems, or operations;

1

DATE IN 10 YEARS OR LESS (Complete Item 11 and Skip Item 12)

(b) foreign government information;

2

EVENT IN 10 YEARS OR LESS (Skip Item 11 and Complete Item 12)

3

DATE NOT TO EXCEED 25 YEARS (Complete Item 11 and Skip Item 12)

4

25X EXEMPTION WITH DATE (Complete Item 11 and Skip Item 12)

5

25X EXEMPTION WITH EVENT (Skip Item 11 and Complete Item 12)

6

50X EXEMPTION WITH DATE (Complete Item 11 and Skip Item 12)

7

50X EXEMPTION WITH EVENT (Skip Item 11 and Complete Item 12)

(c) intelligence activities (including covert action), intelligence sources or
methods, or cryptology;
(d) foreign relations or foreign activities of the United States, including
confidential sources;
(e) scientific, technological, or economic matters relating to the national
security;
(f) United States Government programs for safeguarding nuclear materials
or facilities;
(g) vulnerabilities or capabilities of systems, installations, infrastructures,
projects, plans, or protection services relating to the national security; or
(h) the development, production, or use of weapons of mass destruction.
11. DECLASSIFICATION DATE (MM/DD/YYYY)

12. DECLASSIFICATION EVENT

SECTION C - TO BE COMPLETED FOR DERIVATIVE CLASSIFICATION ACTIONS
13. AUTHORIZED SOURCE FOR CLASSIFICATION AND SOURCE DATE

15. DECLASSIFICATION DATE (MM/DD/YYYY)

14. DECLASSIFICATION INSTRUCTION
1

DATE IN 10 YEARS OR LESS (Complete Item 15 and Skip Item 16)

2

EVENT IN 10 YEARS OR LESS (Skip Item 15 and Complete Item 16)

3

DATE NOT TO EXCEED 25 YEARS (Complete Item 15 and Skip Item 16)

4

25X EXEMPTION WITH DATE (Complete Item 15 and Skip Item 16)

5

25X EXEMPTION WITH EVENT (Skip Item 15 and Complete Item 16)

6

50X EXEMPTION WITH DATE (Complete Item 15 and Skip Item 16)

7

50X EXEMPTION WITH EVENT (Skip Item 15 and Complete Item 16)

8

NO FUTURE ACTION (Skip Item 15 and Item 16)

16. DECLASSIFICATION EVENT

SECTION D - TO BE COMPLETED FOR DECLASSIFICATION ACTIONS
17. REASON FOR DECLASSIFICATION REVIEW

18. NUMBER OF PAGES DECLASSIFIED

1. MANDATORY REVIEW

3. CHALLENGE REQUEST

5. FOIA APPEAL

2. SYSTEMATIC REVIEW

4. FOIA REQUEST

6. AUTOMATIC DECLASSIFICATION

NRC FORM 790 (MM-YYYY)

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INSTRUCTIONS FOR COMPLETING NRC FORM 790
PLEASE COMPLETE THIS FORM ELECTRONICALLY, WHEN POSSIBLE. SAVE THE PDF FILE TO YOUR COMPUTER. CLICK THE SUBMIT BY EMAIL BUTTON BELOW.
FORM WILL BE ELECTRONICALLY SUBMITTED TO THE INFORMATION SECURITY BRANCH RECORD CLASSIFICATION ACTION RESOURCE MAILBOX.
CAUTION: In order to complete and/or submit this form electronically, the contents of the form must be UNCLASSIFIED in their entirety. Please verify that the document
title and authorized sources for classification are UNCLASSIFIED in advance of completing this form.
SECTION A - TO BE COMPLETED FOR ALL CLASSIFICATION ACTIONS
Section A must be completed for all classification actions, to include original classification, derivative classification, and declassification actions.
Item 1

Type or print the full name of the authorized classified in the order of last name, first name, and middle initial (if applicable).

Item 2

Insert the official four-digit authorized classifier's number issued by the NRC.

Item 3

Insert the date that you completed the NRC Form 790 in the format MM/DD/YY.

Item 4

Insert the unclassified document title.

Item 5

Insert the abbreviation of the authorized classifier's facility or NRC office, as appropriate.

Item 6

Insert the date the document was originated or signed in the format MM/DD/YY.

Item 7

Indicate whether this record reflects an original classification, derivative classification, or declassification action. Original classification is an initial determination that
information requires, in the interest of the national security, protection against unauthorized disclosure. Derivative classification is the incorporating, paraphrasing, restating,
or generating in new form information that is already classified, and marking the newly developed material consistent with the classification markings that apply to the source
information. Declassification is the authorized change in the status of information from classified information to unclassified information.

Item 8

Indicate the overall classification level (Top Secret (TS), Secret (S), or Confidential (C)) and category (Restricted Data (RD) or National Security Information (NSI)) of the
document in its entirety or indicate if the document is Unclassified in its entirety.

SECTION B - TO BE COMPLETED FOR ORIGINAL CLASSIFICATION ACTIONS
Item 9

If the document includes National Security Information (NSI), then select all applicable reasons for classification in accordance with Executive Order 13526, “Classified
National Security Information,” Section 1.4, “Classification Categories.” If the document is Unclassified in its entirely or only contains Restricted Data (RD), then leave Item 9
blank.

Item 10

Indicate the declassification instruction associated with the original classification action. Select “Date in 10 Years or Less” if the declassification date is 10 year or less from
the date of original classification. Select “Event in 10 Years or Less” if the declassification event is reasonably expected to occur in 10 year or less from the date of original
classification. Select “Date Not to Exceed 25 Years” if the declassification date is between 10 and 25 years from the date of original classification. Select “25X Exemption
with Date” if the NRC has an approved 25X exemption for the information and the declassification date does not exceed 50 years. Select “25X Exemption with Event” if the
NRC has an approved 25X exemption for the information and the declassification event is reasonably expected to occur within 50 years. Select “50X Exemption with Date” if
the NRC has an approved 50X exemption for the information and the declassification date does not exceed 75 years. Select “50X Exemption with Event” if the NRC has an
approved 50X exemption for the information and the declassification event is reasonably expected to occur within 75 years.

Item 11

Insert the specific date for declassification in the format MM/DD/YY. Item 11 should only be completed if Code 1, 3, 4 or 6 were selected in Item 10. In all other instances,
this item should be left blank.

Item 12

Indicate the specific event for declassification. Item 12 should only be completed if Code 2, 5, or 7 was selected in Item 10. In all other instances, this item should be left
blank.

SECTION C - TO BE COMPLETED FOR DERIVATIVE CLASSIFICATION ACTIONS
Item 13

Indicate the unclassified title of the authorized source used for derivative classification and the date of the source in the format MM/DD/YY. Authorizes sources for
classification include classification guides, source documents, and original classification decisions. If multiple authorized sources are used for classification, then indicate
“Multiple Sources” for Item 13.

Item 14

Indicate the declassification instruction associated with the original classification action. Select “Date in 10 Years or Less” if the declassification date is 10 year or less from
the date of original classification. Select “Event in 10 Years or Less” if the declassification event is reasonably expected to occur in 10 year or less from the date of original
classification. Select “Date Not to Exceed 25 Years” if the declassification date is between 10 and 25 years from the date of original classification. Select “25X Exemption
with Date” if the NRC has an approved 25X exemption for the information and the declassification date does not exceed 50 years. Select “25 Exemption with Event” if the
NRC has an approved 25X exemption for the information and the declassification event is reasonably expected to occur within 50 years. Select “50X Exemption with Date” if
the NRC has an approved 50X exemption for the information and the declassification date does not exceed 75 years. Select “50X Exemption with Event” if the NRC has an
approved 50X exemption for the information and the declassification event is reasonably expected to occur within 75 years. Select “No Future Action” if the document only
contains Restricted Data (RD).

Item 15

Insert the specific date for declassification in the format MM/DD/YY. Item 15 should only be completed if Code 1, 3, 4 or 6 were selected in Item 14. In all other instances,
this item should be left blank.

Item 16

Indicate the specific event for declassification. Item 16 should only be completed if Code 2, 5, or 7 was selected in Item 10. In all other instances, this item should be left
blank.

SECTION D - TO BE COMPLETED FOR DECLASSIFICATION ACTIONS
Item 17

Indicate the reason for the declassification review. Select “Mandatory Review” if the declassification review occurred in response to a request for declassification that meets
the requirements of Executive Order 13526, “Classified National Security Information,” Section 3.5, “Mandatory Declassification Review.” Select “Systematic Review” if the
declassification review was associated with records that have been determined by the Archivist to have permanent historical value in accordance with title 44, United States
Code. Select “Challenge Request” if the declassification review occurred in response to a classification challenge in which an authorized holder believed that the classification
status was improper. Select “FOIA Request” if the declassification review occurred in response to a Freedom of Information Act request. Select “FOIA Appeal” if the
declassification review occurred in response to a Freedom of Information Act appeal. Select “Automatic Declassification” if the declassification of information was based solely
upon the occurrence of a specific date or event as determined by the original classification authority; or the expiration of a maximum time frame for duration of classification
established under Executive Order 13526, “Classified National Security Information.”

Item 18

Indicate the number of pages declassified