Name

Date

Signature
TITLE 18 USC 1001 makes it a crime for any person to knowingly and wildly make to any department or agency of the United States any false,
fictitious, or tradutant statements to any matter within is jurisdiction.
Coop Donderton We DOC Corte Camery. DOE OCAMERE DOE EK Goldenrod, Unity Copy

• GPO: 190 122

DEPARTMENT OF ENERGY
Germantown, MD 20875

APPENDIX G - STANDARD REMITTANCE ADVICE FOR PAYMENT OF FEES

General Information

Purpose
Standard Remittance Advice (RA) form is designed to serve as the source document for entries into the Departments accounting records to transmit data from
Purchasers concerning payment of their contribution to the Nuclear Waste Fund.
Who Shall Submit
The RA must be submitted by Purchasers who signed the Standard Contract for Disposal of Spont Nuclear Fuel andior High-Level Radioactive Waste. Submit
Copy 1, 2, and 3 to DOE, Orlice of the Controller, Special Accounts and Payroll Division and retain Copy 4.
Where to Submit
Purchasers shall forward completed RA to:
U.S. Department of Energy
Office of the Controller
Special Accounts and Payroll Division (C-216 GTN
Box 500
Germantown, MD 20875-0500
Request for further information, additional forms, and instructions may be directed in writing to the address bowo or by telephone to (301) 350-4014
When to Submit
For olectricity penerated on or after 4-7-83 loes thall be paid quarterly by the purchaser and must be moved by DOE not
business day of the month following the end of each assigned three month period. Payment is by electronic wire transfer only.
Sanctions
The timely submission of RA by a Purchaser is mandatory. Failure b Ble may result in late penalty looss provided by Artido VI.Cd the Contra lor
Disposal of Spont Nuclear Fuel and/or High-Lovel Re

was Provisions Regarding the Confidentiality of Intormation The information contained in those forme may be information which is exempt from disclosuro bo he public under the comption for redo secret and confidential commercial Information specified n the Freedom of Information Act of 5 USC 522bX OXFOU) a (prohidin hrom public reload by 18 USC 1805 However, bolore a determination can be made that particular Information is within the coverno ritheo then statutory provision, the portion submitting the Information must make a showing satistactory the Department concerning is confidential nature. Therefore, respondents should stan briefly and specifically fon a clement-by-element bugia il poseblo), in later nccompanying submission of the form why they consider the information concemed to be a rede secret or other proprietary Information, whether such normation is asomarily reated a confidential Information by their companies and the industry, and the type of competitive hardship that would result from disclosure of the information. In accordando in the provisions of 10 CFR 1004.11 of DOE's FOU regulations, DOE i determine whether any inbormation submind thould be with held from public diadomun. I DOE receives a response and does not receive a request, with substantive justification, that the Intormation submind should not be relotsod to the public DOE may assume that the respondent does not objedib disclosure b the public of any information submited on the torm. A new written justification need not be submitted each time the NWPA-B30G is submitted it:

a. views concerning information items idondfied as privileged or confidential have not changed and

b. a written justification setting forth respondents viows in this regard was previously submued. In accordance with the cited statutes and other applicable authority, the intormation must be made available upon request, to the Congress or any committee of Congress, the General Accounting Office, and other Federal agencies authorized by law to receive such information.

INSTRUCTIONS FOR COMPLETING STANDARD REMITTANCE

ADVICE FOR PAYMENT OF FEES Section 1.0 Identification Information

1.1 Name of Purchaser as it appears on the Standard Contract, the mailing address, state, and zip code.

Name and telephone number of person responsible for the completion of this form. 1.3 Standard Contract identification number as assignod by DOE.

Period covered by this advice and date of this payment. Any period diferent from the assigned three month period should be explained on a separate attachment.

Section 2.0 Spent Nudear Fuel (SNF) Fee

Enter the number of reactors for which the purchaser had irradiated fuel as of midnight between 617 April 1983 (equal to the number of Annex B Forms
attached).
Total amount owed to the Nudear Waste Fund for spent fuel used to generate electricity prior to April 7, 1983 (See Annex B for calculation).
Self explanatory.
Ten year Treasury Note rate on the date the payment is made, to be used it payments are being made using the 40 quarter option or if lump sum

payment is made after June 30, 1985.
2.5 Unpaid balance before this payment is made.
2.6 Enter the payment option (1.2, or 3) chosen. The selection of payment option must be made within two years ol Standard Contrad execution

2.7 Total payment of lee which this advice represents. Show principal, interest, and total. Section 3.0 Foe for Electricity Generated and Sold (

M Wh) 3.1 Enter the number of reactors the Purchaser is reporting on during this reporting period. 2 Enter total electricity generated and sold during the reporting period from all reactors being reported. This is the sum ol Station Total figures of line 42

from all Annex A forms attached, expressed in megawan hours. 3 Current Fee Rate as provided by DOE initially 1.0 M Wh which is equal to 1.0 StWh). 3.4 Total Fee for Electricity Generated and Sold (

M Wh) represented by this advice. Section 4.0 Underpaymenvlate payment (as nonfied by DOE)

4.1.4.6 Sell Explanatory. Section 5.0 Other Credits Claimed

Represents all items for which a purchaser may receive credit, as specified in the Standard Contract. Section 6.0 Total Remittance

6.1 - 6.6 This section is a summary of the payments made in the previously mentioned categories with this remittance, Section 7.0 Certification

Enter the name and title of the individual your company has designated to certify the accuracy of the data. Sign the Certification block and enter the current date.

U.S. Department of Energy

OMB No. 1901-0260 Energy Information Administration ANNEX A TO APPENDIX G

(Expires 11/30/93) Form NWPA-830G

Standard Remittance Advice for Payment of Fees

Section 1. Identification Information: Please first read the Instructions on the back. 1.1 Purchaser Information:

|| 1.3 Station Name: -
1.11 Name:
1.12 Address:
1.13 Attention:-

1.4 Standard Contract Identification
1.14 City:-

Number: 1.15 State:

- 1.16 Zip: 1.17 Utility ID Number —

1.5 Perlod Covered (MM/DD/YY): 1.2 Contact Person: 1.21 Name:

1.51 From:

To:_ 1
1.22 Title:
1.23 Phone No.:

Ext.:

1.52 Date of This Submission:_ _
Section 2. Net Electricity Generated Calculation
Hem

Unit 1.
Unit 2

Unlt 3 Station Total" 2.1 Unit ID Code: 22 Gross Thermal Energy Generated (MWh): 2.3 Gross Electricity Generated (MWh): 2.4 Nuclear Station Use While At Least One

Nuclear Unit Is In Service** (MWh): 2.5 Nuclear Station Use While All Nuclear

Units Are Out 01 Service (MWh): 2.6 Net Electricity Generated (MWh)

(Item 2.3 minus Item 2.4); 2.7 Footnote (if any): For a nuclear station with more than one reactor and different ownerships for each reactor, a separate Annex A will be required. **Usites unable to meter individual unit use shall report estimated unit use and shall explain in a footnote how the unit data were estimated.

Section 3. Total Energy Adjustment Factor Calculation 3.1 Welghted Energy Adjustment Adj. for Sales to Adjustment for Factor Calculation

ultimate Consumer Sales for Resale
(ASC)

(ASR)
Fraction Sales to Fraction National Owner's Owner's Welghted
of Sales ultimate of Sales average

Energy
Share

Energy
to ult. Consumer for
Adj. Ad).

Ad). Name of Nuclear Consumer Adj. Factor Resale Factor Factor

Factor Station Owner(s) (FSC) (SCAF (FSR) (NAF) (OEAF)

(WEAF)