AN 241.5
(06/2019)
INSERT CLASSIFICATION LEVEL AND CATEGORY (IF RD OR FRD) OR UNCLASSIFIED (UCNI, OR OFFICIAL USE ONLY)
INSERT CLASSIFICATION LEVEL AND CATEGORY (IF RD OR FRD) OR UNCLASSIFIED (UCNI, OR OFFICIAL USE ONLY)
FORM CONTAINS WEAPON DATA? (“X” appropriate space) _______ YES ______ NO
U.S. DEPARTMENT OF ENERGY
RESTRICTED ANNOUNCEMENT OF U.S. DEPARTMENT OF ENERGY (DOE)
CLASSIFIED AND UCNI SCIENTIFIC AND TECHNICAL INFORMATION (STI)
RECORD STATUS (select one): _____New _____Revised Metadata _____Revised STI Product
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Part I: STI PRODUCT DESCRIPTION
A. STI PRODUCT TYPE (select one):
____ 1. Technical Report
____ 2. Conference Paper or Presentation/Proceedings ___ Paper ___ Proceedings
Conference Information (title, location, dates)_____________________________________________________
____ 3. Journal Article
a. Journal Name ___________________________________________________________________________
b. Volume _________c. Issue ______d. Serial identifier (e.g., ISSN or CODEN) ________________________
____ 4. Software Manual (The actual software package should be made available simultaneously.)
____ 5. Patent/Patent Application
a. Date Filed (mm/dd/yyyy) ____/____/________b. Date Priority (mm/dd/yyyy) ____/____/________
c. Patent Assignee ___________________________________________________________________________
____ 6. Drawing
____ 7. Data
____ 8. Collection
____ 9. Computer-Related
B. STI PRODUCT TITLE(S) ___________________________________________________________________________
C. AUTHOR(S) _______________________________________________________________________________________
E-mail Address(es): __________________________________________________________________________________
D. STI PRODUCT IDENTIFIERS
1. Report/Product Number(s) _________________________________________________________________________
2. Contract Number(s) ______________________________________________________________________________
3. Other Identifying Number(s) _______________________________________________________________________
E. ORIGINATING RESEARCH ORGANIZATION) _______________________________________________________
F. PUBLICATION/ISSUE DATE (mm/dd/yyyy) ____/____/________
G. LANGUAGE (if non-English) ______________________________
H. COUNTRY OF PUBLICATION (if other than U.S.)_______________________________________________________
I. SPONSORING ORGANIZATION ____________________________________________________________________
J. PRODUCT ORIGIN (Specify if the document is DOE or Non-DOE sponsored.) ___ DOE Project ___ Non-DOE Project
K. SUBJECT CATEGORIES (list primary one first) (specify subject category schema used)
______________________________________________________________________________________________________
______________________________________________________________________________________________________
L. KEYWORDS (identify thesaurus used [ if applicable])
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
M. DESCRIPTION/ABSTRACT (may be attached)
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
N. IS STI PRODUCT ACCOUNTABLE?
O. RELATED DOCUMENT INFORMATION (information useful to include in published announcement record which is
not suited for any other field on this announcement notice)
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
AN 241.5
INSERT CLASSIFICATION LEVEL AND CATEGORY (IF RD OR FRD) OR UNCLASSIFIED (UCNI, OR OFFICIAL USE ONLY)
INSERT CLASSIFICATION LEVEL AND CATEGORY (IF RD OR FRD) OR UNCLASSIFIED (UCNI, OR OFFICIAL USE ONLY)
FORM CONTAINS WEAPON DATA? (“X” appropriate space) _______ YES ______ NO
Part II: STI PRODUCT MEDIA/FORMAT AND TRANSMISSION
A. MEDIA/FORMAT INFORMATION
1. Medium of STI product is: ____ Paper ____ Electronic document ____Computer medium
____ Audiovisual material ____ Other (specify) ________________________________________________
____ No full text (submit PDF file describing location of document)
2. If Electronic Document, file format is:
____ PDF Searchable ____ PDF Non-Searchable ____ Other (specify) _________________________________
3. Size of STI product _____________________________________________________________________________
4. If Computer Medium, Video or Audiovisual Material:
a. Quantity/type (specify) ________________________________________________________________________
b. Machine compatibility (specify) _________________________________________________________________
c. Other information about product format a user needs to know: _________________________________________
B. TRANSMISSION INFORMATION (CLASSIFIED MATTER AND UCNI SUBMITTED ELECTRONICALLY
MUST BE TRANSMITTED VIA ESN!)
1. STI Product is being transmitted:
___ Electronically via ESN
___ Via mail or shipment (e.g., Registered Mail) (Acceptable formats: paper, CD-ROM, videocassettes, etc.)
2. Electronic Information Product File Name (of transmitted full-text document ) ________________________________
_______________________________________________________________________________________________
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Part III: STI PRODUCT REVIEW/RELEASE INFORMATION
A. CLASSIFIED ACCESS LIMITATIONS (select the applicable classification level (TOP SECRET not allowed), category,
and sigma)
1. Classified STI product
a. Classification level/category_______/_______
b. Caveats _____________________________________
2. Programmatic Approval Authority Category (DOE/OSTI-3679) ___________________________________________
If Category 72 (Weapon Data), then:
a. Weapon Data Sigma(s): ________________________
b. ____ Has been reviewed for Sigma 14,15
c. ____ Has been reviewed for Sigma 18
d. ____ Has been reviewed for Sigma 20
B. UCNI ACCESS LIMITATIONS
____ UCNI STI Product
Caveats ___________________________________________
C. OTHER CRITERIA LIMITING ACCESS OR RESTRICTING ANNOUNCEMENT OF THIS PRODUCT:
___________________________________________________________________________________________________
D. RELEASING OFFICIAL
I verify that all necessary reviews have been completed as described in DOE O 241.1B, including Protected
Personal Identity Information (PII). The STI product should be released in accordance with the Restricted Distribution or
Access Limitation markings above.
Released by (name) ________________________________________________ Date (mm/dd/yyyy) _____/_____/_________
E-mail ___________________________________________________________ Phone (____)_________________________
Releasing Official Comments ______________________________________________________________________________
E. TECHNICAL CONTACT (if appropriate, the organization or site contact to include in published citations who would
receive any external questions about the content of STI Product or the research information contained therein)
Name and/or Position _____________________________________________________________________________________
Organization ____________________________________________________________________________________________
E-mail ___________________________________________________________
Phone (____) ______________________________ Fax (____) ______________________________