Fillable Nrc835 (Nuclear Regulatory Commission)

Fill Online, Printable, Fillable, Blank Nrc835 (Nuclear Regulatory Commission) Form

Use Fill to complete blank online NUCLEAR REGULATORY COMMISSION (MD) pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

Nrc835 (Nuclear Regulatory Commission)

On average this form takes 10 minutes to complete

The Nrc835 (Nuclear Regulatory Commission) form is 3 pages long and contains:

  • 0 signatures
  • 11 check-boxes
  • 35 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Nuclear Regulatory Commission

BROWSE NUCLEAR REGULATORY COMMISSION (MD) FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
NUCLEAR REGULATORY COMMISSION
OFFICE OF THE INSPECTOR GENERAL
FAR CONTRACTOR REPORTING FORM
NRC FORM 835
(3-2010)
U.S. NUCLEAR REGULATORY COMMISSION
Page 1 of 3
NRC FORM 835 (3-2010)
PRINTED ON RECYCLED PAPER
This form is to allow the contractor to notify, in writing, the agency (NRC) Office of the Inspector General,
whenever the contractor has credible evidence that a principal, employee, agent, or subcontractor of the
contractor has committed a violation of the Civil False Claims Act or a violation of Federal criminal law
involving fraud, conflict of interest, bribery, or gratuity violations in connection with the award, performance, or
closeout of a contract or any related subcontract. The individual completing this form must be an officer or
manager empowered to speak for the company by filing this report.
Please print a copy of this form for your records before faxing or mailing. Mandatory fields are denoted with
an asterisk (*).
If you wish to provide information that does not fall within these guidelines, please visit the OIG Hotline Web
Site at www.nrc.gov/insp-gen/oighotline.html.
Instructions: Your Disclosure Information:
Fill in, print, and sign the form.
Your first name*
Send by mail or facsimile to:
Your last name*
Your title*
Nuclear Regulatory Commission
Your business e-mail*
Office of the Inspector General
Confirm your business e-mail*
Attention: FAR Contractor Reporting
Your telephone number*
11555 Rockville Pike - MS O-5E13
Rockville, MD 20852
Fax - 301-415-5091
Company Information
Name of Company *
Company President or Director *
Affected Corporate Branch *
Doing Business As *
Business Address *
City, State, and Zip Code *
Country *
Telephone *
Fax Number *
Web Site *
NUCLEAR REGULATORY COMMISSION
OFFICE OF THE INSPECTOR GENERAL
FAR CONTRACTOR REPORTING FORM
NRC FORM 835
(3-2010)
U.S. NUCLEAR REGULATORY COMMISSION
Page 2 of 3
NRC FORM 835 (3-2010)
PRINTED ON RECYCLED PAPER
Contract Information
DUNS Number
NRC Contract Number
NRC Contract Officer
Short Title
Description of Services/Supplies/Systems
Contract Expiration
Obligated Funds
Type of Contract
Contract Value
Firm Fixed Price or Cost Reimbursable
List of all Federal agencies with whom you or your company are conducting business
Incident
Description of Loss
Estimated Amount of Loss
Potential Violation
Has an investigation been conducted?
Date Contractor Learned of Violation
Yes No
Attributes
Duration of the activity longer than 3 months
Does the incident you are reporting include any of the following attributes? (check all that apply)
Multiple individuals involved
Actual or potential security compromise
Actual or potential employee/public safety/health threat
Actual or potential misuse of personally identifiable information
Actual or potential national security threat
Other (Explain in detail)
NUCLEAR REGULATORY COMMISSION
OFFICE OF THE INSPECTOR GENERAL
FAR CONTRACTOR REPORTING FORM
NRC FORM 835
(3-2010)
U.S. NUCLEAR REGULATORY COMMISSION
Page 3 of 3
NRC FORM 835 (3-2010)
PRINTED ON RECYCLED PAPER
Comments
Please provide a complete description of the facts and circumstances surrounding the reported activities,
including the evidence forming the basis of this report, the names of the individuals involved, dates, location,
how the matter was discovered, potential witnesses and their involvement and any corrective action taken.
Certification
I certify that the information contained herein is true and correct to the best of my knowledge.
To access the Federal Acquisition Regulation click on these links:
NOTE: Please provide the names, email contact, and business phone for any individuals involved and/or
potential witnesses.
Please list any other entities you are notifying:
Name: Date:
I understand and acknowledge that the submission of the foregoing Contractor Disclosure Program
submission does not bar, prohibit, foreclose, or preclude the Government from pursuing any and all criminal,
civil, and/or administrative remedies provided to it by law and/or regulation against (a) the business
entity(ies) making the foregoing Contractor Disclosure Program Submission, (b) any other business entities
mentioned in the submission, and/or any individuals mentioned in the submission.
http://www.usda.gov/oig/webdocs/FARAmendment2008.pdf
http://www.access.gpo.gov/su_docs/fedreg/frcont08.html
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

Nrc835 (Nuclear Regulatory Commission)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 25 July 2020

Message

View Audit Log
Print With Audit Log
Duplicate Document