+----------------------------------------------+-----------------------+
| ATTACHMENT 1: SAMPLE FORMAT FRONT pAGE       |                       |
| OUO/UCNI RECORD MARKINGS                     |                       |
+==============================================+=======================+
| Sample Format Front Page OUO/UCNI Record     | ![](medi              |
| Markings                                     | a/image1.png){width=" |
|                                              | 1.6597222222222223in" |
|                                              | height="0.859722      |
|                                              | 2222222223in"}Records |
|                                              | Use only              |
+----------------------------------------------+-----------------------+
| **OUO Records:**                             |                       |
|                                              |                       |
| +-----------------------------------------+  |                       |
| | **OFFICIAL USE ONLY**                   |  |                       |
| |                                         |  |                       |
| | May be exempt from public release under |  |                       |
| | the Freedom of Information Act (5       |  |                       |
| | U.S.C. 552), exemption number and       |  |                       |
| | category:                               |  |                       |
| | \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_  |  |                       |
| |                                         |  |                       |
| | Department of Energy review required    |  |                       |
| | before public release.                  |  |                       |
| |                                         |  |                       |
| | Name/Organization:                      |  |                       |
| | \_\_                                    |  |                       |
| | \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\ |  |                       |
| | _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |  |                       |
| |                                         |  |                       |
| | Date:                                   |  |                       |
| | \_\_\_\_\_\_\_\_\_\_\_\_\_\_            |  |                       |
| | \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\ |  |                       |
| | _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |  |                       |
| |                                         |  |                       |
| | Guidance (if applicable):               |  |                       |
| | \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\   |  |                       |
| | _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |  |                       |
| +-----------------------------------------+  |                       |
|                                              |                       |
| **"Document transmitted contains OUO         |                       |
| information"**                               |                       |
|                                              |                       |
| **UCNI Records Markings (bottom of cover     |                       |
| page):**                                     |                       |
|                                              |                       |
| +-------------------+--------------------+   |                       |
| | **Reviewing**     | **UNCLASSIFIED     |   |                       |
| |                   | CONTROLLED NUCLEAR |   |                       |
| | **Official:       | INFORMATION**      |   |                       |
| | \_\               |                    |   |                       |
| | _\_\_\_\_\_\_\_\_ | **NOT FOR PUBLIC   |   |                       |
| | \_\_\_\_\_\_\_\_\ | DISSEMINATION**    |   |                       |
| | _\_\_\_\_\_\_\_** |                    |   |                       |
| |                   | **Unauthorized     |   |                       |
| | **(Nam            | dissemination      |   |                       |
| | e/Organization)** | subject to civil   |   |                       |
| |                   | and criminal       |   |                       |
| | **Date:           | sanctions under    |   |                       |
| | \_\_\_\           | Section 148 of the |   |                       |
| | _\_\_\_\_\_\_\_\_ | Atomic Energy Act  |   |                       |
| | \_\_\_\_\_\_\_\_\ | of 1954, as        |   |                       |
| | _\_\_\_\_\_\_\_** | amended (42 USC    |   |                       |
| |                   | 2168)**            |   |                       |
| +-------------------+--------------------+   |                       |
+----------------------------------------------+-----------------------+