NRC FORM 754

(03-21-2023)

U.S. NUCLEAR REGULATORY COMMISSION

ARMED SECURITY PERSONNEL 

 FIREARMS BACKGROUND CHECK

APPROVED BY OMB: NO. 3150-0204 EXPIRES: 03/31/2026 

Estimated burden per response to comply with this mandatory information collection request: 2.2 

hours. NRC uses the information to verify that personnel protecting NRC-regulated entities are not 

prohibited from receiving, possessing, transporting, importing, or using covered weapons as part of 

the performance of their official duties. Send comments regarding burden estimate to the FOIA, 

Library, and Information Collections Branch (T-6 A10M), 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, (3150-0204), Attn: Desk Officer for 

the Nuclear Regulatory Commission, 725 17th Street NW, Washington, DC 20503; email: 

oira_submission@omb.eop.gov. 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. 

NICS Transaction Number (NTN)

Warning: Security personnel protecting NRC designated facilities, radioactive material, or other property are not authorized 

to receive, possess, transport, import, or use firearms pursuant to § 161A of The Atomic Energy Act of 1954, as amended, 

42 U.S.C. § 2201a, if prohibited under Federal or State law. The information you provide will be used to verify that you are 

not prohibited under Federal or State law from receiving, possessing, transporting, importing, or using any firearms. 

Prepare in original only. Must be completed personally by individual. All entries must be in ink. Please type or print all 

information. Read the Important Notices, Instructions, and Definitions on this form. 

1. Individual's Full Name (Last, First, Middle) (If no middle name state "NMN")

2. Other Previously Used Names (e.g., Maiden) (Last, First, or Middle) 

3. Current Residence Address (Cannot be a post office box) (U.S. Postal abbreviations are acceptable) (See Instruction 3)

Number and Street Address City County State Zip Code

4. Current Duty Station Location(s). (Use U.S. Postal abbreviations for the State or Territory) (See Instruction 4)

 5. Place of Birth

U.S. City/State - or - Foreign Country

 6. Height

Ft. In.

7. Weight

lb.

8. Gender

Male

Female

10. Social Security Number (Enter 9 numeric digits) 11. Unique Personal Identification Number (UPIN), if applicable (See Instruction 5)

 12. Race (Ethnicity) (Check one or more boxes) (See Instruction 6)

American Indian or Alaska Native Black or African American Native Hawaiian or Other Pacific Islander

Hispanic or Latino Asian White

 13. What is your country of citizenship? (List/check more than one, if applicable)

United States of America Other (Specify):

14. If you are not a citizen of the United States, what is your U.S. issued alien number or admission number?

15. If you are a nonimmigrant alien, what exception do you fall under as described in Important Notice 3, Exception 2? (Specify the documentation showing an 

exemption to the nonimmigrant alien prohibition)

I certify that the answers above are true and correct. I have read and understand the Important Notices, Instructions, and 

Definitions for this form. I understand that making any false oral or written statement is a crime punishable as a felony.

16. Security Personnel's Signature 17. Certification Date (MM/DD/YYYY)

NRC FORM 754 (03-21-2023) Page 1 of 3

9. Birth Date (MM/DD/YYYY)

*Note: Social Security Numbers must not be visible on the outside of any package sent by mail.
NRC FORM 754

(03-21-2023)

U.S. NUCLEAR REGULATORY COMMISSION

ARMED SECURITY PERSONNEL FIREARMS BACKGROUND CHECK (Continued)

Important Notices

1. Purpose of the Form: The information and certification on this 

 form are designed to support a verification that security personnel 

 protecting U.S. Nuclear Regulatory Commission (NRC) designated 

 facilities, radioactive material, or other property are not prohibited 

 from receiving, possessing, transporting, or using firearms as part 

 of the performance of their official duties under § 161A of the 

 Atomic Energy Act of 1954, as amended (AEA), 42 U.S.C. § 

 2201a. Submission of this form is mandatory for security 

 personnel of license holders who apply to the NRC for Section 

 161A. authority. Failure to submit this form will result in the 

 individual being denied access to firearms as part of their official 

 security duties at NRC-regulated entities.

 Evaluation of the information contained in this form will permit the 

 NRC to verify that individuals who are prohibited from possessing 

 or receiving any firearms under Federal or State law do not 

 possess or receive firearms (including enhanced weapons) as part 

 of their current or proposed official duties as security personnel. 

 This determination is required of all security personnel protecting 

 NRC designated facilities, radioactive material, or other property.

2. Background Checks: Section 161A requires that security 

 personnel receiving, possessing, transporting, or using a covered 

 weapon shall be subject to a background check by the Attorney 

 General, based on fingerprints and including a background check 

 under section 103(b) of the Brady Handgun Violence Prevention 

 Act (Brady Act), Public Law 103-159, 18 U.S.C. § 922(t), to 

 determine whether the person is prohibited from possessing or 

 receiving firearms under Federal or State law. The Brady Act 

 provides for the submission of information to the Federal Bureau of 

 Investigation's (FBI's) National Instant Criminal Background Check 

 Systems (NICS) to verify that an individual is not prohibited under 

 Federal or State law from possessing or receiving firearms.

3. Prohibited Persons: Generally, 18 U.S.C. § 922 prohibits the 

 shipment, transportation, receipt, or possession in or affecting 

 interstate commerce of firearms by anyone who: (1) has been 

 convicted of a misdemeanor crime of domestic violence; (2) has 

 been convicted of a felony, or any other crime, punishable by 

 imprisonment for a term exceeding one year (this does not include 

 State misdemeanors punishable by imprisonment of two years or 

 less); (3) is a fugitive from justice; (4) is an unlawful user of, or 

 addicted to, marijuana or any depressant, stimulant, or narcotic 

 drug, or any controlled substance; (5) has been adjudicated 

 mentally defective or has been committed to a mental institution; 

 (6) has been discharged from the Armed Forces under 

 dishonorable conditions; (7) has renounced his or her U.S. 

 citizenship; (8) is an alien illegally in the United States or a 

 nonimmigrant alien; or (9) is subject to certain restraining orders. 

 Furthermore, § 922 prohibits the shipment, transportation, or 

 receipt of firearms to anyone who is under an indictment or 

 information in any court for a felony, or any other crime, punishable 

 by imprisonment for a term exceeding one year.

 Exception 1: A person who has been convicted of a felony, or any 

 other crime, for which the judge could have imprisoned the person 

 for more than one year, or has been convicted of a misdemeanor 

 crime of domestic violence, is not prohibited from receiving, 

 possessing, transporting, importing, or using covered weapons if: 

 (1) under the law of the jurisdiction where the conviction occurred, 

 the person has been pardoned, the conviction has been expunged 

 or set aside, or the person has had certain civil rights (the right to 

 vote, sit on a jury, and hold public office) restored AND (2) the 

 person is not prohibited by the law of jurisdiction where the 

 conviction occurred from receiving or possessing firearms.

 Exception 2: A nonimmigrant alien is not prohibited from 

 possessing or receiving a covered weapon as part of their official 

 duties at NRC regulated facilities if the alien: (1) meets the 

 exceptions of 18 U.S.C. § 922(y)(2)(B), (y)(2)(C), or (y)(2)(D); or 

 (2) has received a waiver from the Attorney General of the United 

 States (See 18 U.S.C. § 922(y)(3) for additional information on 

 waivers.)

4. Restraining Order: Under 18 U.S.C. § 922, firearms may not be 

 possessed or received by persons subject to a court order that: 

 (1) was issued after a hearing which the person received actual 

 notice of and had an opportunity to participate in; (2) restrains 

 such person from harassing, stalking, or threatening an intimate 

 partner or child of such intimate partner or person, or engaging in 

 other conduct that would place an intimate partner in reasonable 

 fear of bodily injury to the partner or child; and (3)(i) includes a 

 finding that such person represents a credible threat to the 

 physical safety of such intimate partner or child; or (ii) by its terms 

 explicitly prohibits the use, anticipated use, or threatened use of 

 physical force against such intimate partner or child that would 

 reasonably be expected to cause bodily injury.

5. NICS Responses: The FBI will provide a "proceed," "delayed," or 

 "denied" NICS response and a NICS transaction number to the 

 NRC that will be forwarded to you via your submitting license 

 holders.

Instructions to Security Personnel

1. Individuals must personally complete this form and certify (sign) 

 that the information on this form is true and correct.

2. If the individual is a member of the Armed Forces on active duty 

 and is receiving, possessing, transporting, or using covered 

 weapons in the State where his or her permanent duty station is 

 located, but does not reside at his or her permanent duty station, 

 the security personnel must list his or her permanent duty station 

 address in the response to question 4 and his or her residence 

 address in response to question 3.

3. Current Residence Address: If you are a U.S. citizen with two 

 States of residence, you should list your current residence address.

4. Duty Station Location(s): Enter the U.S. Postal abbreviation for 

 the State or Territory for the duty station location. Multiple States 

 or Territories may be entered for multiple duty stations. For 

 personnel escorting shipments of radioactive material or other 

 property, enter the State or Territory affected by the shipment or 

 enter "CONUS."

5. Unique Personal Identification Number (UPIN): If you have a 

 UPIN issued to you by the FBI's NICS Voluntary Appeal File 

 (based upon previous firearms transactions or based upon 

 previous firearms security background checks), you should enter 

 the UPIN under question 11. Entry of a UPIN is voluntary. 

 However, failure to provide your issued UPIN may result in a 

 "delayed" or "denied" NICS response.

6. Race (Ethnicity): For any other race or ethnicity that does not fall 

 within the indicated categories, please select the closest 

 representation.

 A person who has been convicted of a misdemeanor crime of 

 domestic violence also is not prohibited unless: (1) the individual 

 was represented by a lawyer or gave up the right to a lawyer; and 

 (2) if the person was entitled to a jury, was tried by a jury, or gave 

 up the right to a jury trial.

NRC FORM 754 (03-21-2023) Page 2 of 3
NRC FORM 754

(03-21-2023)

U.S. NUCLEAR REGULATORY COMMISSION

ARMED SECURITY PERSONNEL FIREARMS BACKGROUND CHECK (Continued)

NRC FORM 754 (03-21-2023) Page 3 of 3

Definitions

1. Under indictment or information or conviction in any court: 

 An indictment, information, or conviction in Federal, State, or local 

 court.

2. Misdemeanor Crime of Domestic Violence: A Federal, State, or 

 local offense that is a misdemeanor under Federal or State law and 

 has, as an element, the use or attempted use of physical force, or 

 the threatened use of a deadly weapon, committed by a current or 

 former spouse, parent, or guardian of the victim, by a person with 

 whom the victim shares a child in common, by a person who is 

 cohabiting with, or has cohabited with the victim as a spouse, 

 parent, or guardian, or by a person similarly situated to a spouse, 

 parent, or guardian of the victim. The term includes all 

 misdemeanors that have as an element the use or attempted use 

 of physical force or the threatened use of a deadly weapon (e.g., 

 assault and battery), if the offense is committed by one of the 

 defined parties.

3. Intimate Partner: An "intimate partner" of a person is: the spouse 

 or former spouse of the person, the parent of a child of the person, 

 or an individual who cohabits or has cohabited with the person.

4. State of Residence: The State in which an individual resides. An 

 individual resides in a State if he or she is present in a State with 

 the intention of making a home in that State. If an individual is a 

 member of the Armed Forces on active duty, his or her State of 

 residence also is the State in which his or her permanent duty 

 station is located. An alien who is legally in the United States is a 

 resident of a State only if the alien is residing in the State and has 

 resided in the State continuously for at least 90 days immediately 

 prior to the date of submission of this form.

5. Nonimmigrant Alien: An alien in the United States in a 

 nonimmigrant classification. The definition includes, in large part, 

 persons traveling temporarily in the United States for business or 

 pleasure, persons studying in the United States who maintain a 

 residence abroad, and certain foreign workers. The definition does 

 NOT include permanent resident aliens.

6. Unique Personal Identification Number (UPIN): For individuals 

 approved to have information maintained about them in FBI's NICS 

 Voluntary Appeal File (VAF), NICS will provide them with a UPIN 

 for their use in future firearms transactions or firearms background 

 checks under § 161A of the AEA.

7. Covered Weapon: Covered weapon means any handgun, rifle, 

 shotgun, short-barreled shotgun, short-barreled rifle, semi- 

 automatic assault weapon, machine gun, ammunition for any such 

 weapon, or large capacity ammunition feeding device as specified 

 under section 161A. The terms "handgun, rifle, shotgun, short- 

 barreled shotgun, short-barreled rifle, semi-automatic assault 

 weapon, machine gun, ammunition, and large capacity ammunition 

 feeding device" have the same meaning provided for these terms 

 in 18 U.S.C. § 921(a).

PRIVACY ACT STATEMENT 

NRC FORM 754, ARMED SECURITY PERSONNEL FIREARMS 

BACKGROUND CHECK

Pursuant to 5 U.S.C. 552(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 754. 

This information is maintained in a system of records designated 

as NRC-39, described at 84 Federal Register 71568 (December 

27, 2019), or the most recent Federal Register publication of the 

NRC's "Republication of Systems of Records Notices" that is 

located in the NRC's Agencywide Documents Access and 

Management System (ADAMS).

1. AUTHORITY: 42 U.S.C. 2011 et seq.; 42 U.S.C. 2165, 

2201(i), 2201a, and 2284; 42 U.S.C. 5801 et seq.; Social 

Security Number Fraud Prevention Act of 2017, 42 U.S.C. 405 

note; Executive Order (E.O.) 9397, as amended by E.O. 13478; 

E.O. 10450, as amended; E.O. 10865, as amended; E.O. 13467; 

E.O. 13526; E.O. 13587; 10 CFR parts 10, 11, 14, 25, 50, 73, 95; 

OMB Circular No. A-130, Revised; 5 CFR parts 731, 732, and 

authorities cited therein.

2. PRINCIPAL PURPOSE(S): This form is used to perform a 

background check to verify that an individual is not prohibited 

from receiving, possessing, transporting, importing, or using 

covered weapons as part of the performance of their official 

duties.

3. ROUTINE USE(S): This information will be used to determine 

eligibility to receive, possess, transport, or import covered 

weapons. The information may also be disclosed to an 

appropriate Federal, State, local or foreign agency in the event 

the information indicates a violation or potential violation of law 

and in the course of an administrative or judicial proceeding. In 

addition, this information may be transferred to an appropriate 

Federal, State, local and foreign agency to the extent relevant 

and necessary for it to carry out its responsibilities under 161A of 

the Atomic Energy Act of 1954, as amended. Information may 

also be disclosed, 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, or to NRC-paid experts, 

consultants, and others under contract with the NRC, on a needto-know basis.

4. WHETHER DISCLOSURE IS MANDATORY OR 

VOLUNTARY AND EFFECT ON INDIVIDUAL OF NOT 

PROVIDING INFORMATION: Disclosing this information is 

mandatory for security personnel of licensees and certificate 

holders who apply to the NRC for authority to possess covered 

weapons under section 161A of the Atomic Energy Act of 1954, 

as amended. Failure to submit a completed form will result in the 

individual being denied access to any covered weapons as part 

of their official security duties at NRC-regulated entities. The 

social security number is required to verify the individual's 

identity to facilitate the background check requirements.

5. SYSTEM MANAGER(S) AND ADDRESS: Director, Division 

of Facilities and Security, Office of Administration, U.S. Nuclear 

Regulatory Commission, Washington, DC 20555-0001.