United States Nuclear Regulatory Commission - Protecting People and the Environment

Privacy Act Statement

Digital Credential Request - Registration Information
Please enter the following information and then click Continue to go to next screen.
First Name: Required Middle: Last: Required Suffix: 
Please enter the Company Name that you work for. This information will be used to communicate with you regarding this application.  Company Name: Required
Please enter the e-mail address that you use at the place of business represented in this request. This information will be used to communicate with you regarding this application.  Business Email: Required Please enter your Company telephone number including area code in the following format XXX-XXX-XXXX.   Company Phone Number:   Required   Extension:  
Please enter street address.   Home Street Address: Required Please enter street address if more space needed  Home Address 2:  
please enter home city  Home City: Required
US Address Canadian Address
Please enter your home telephone number including area code in the following format XXX-XXX-XXXX.   Home Phone: Required
OTP-Hardware Security Token - A hardware credential with the ability to generate Security Codes that may be use for authentication purposes. <br> OTP-Software Security Token - Similar to OTP-Hardware tokens, these that can be installed on your mobile smart phone.<br> Software Digital Certificate - An electronic credential that uses public key cryptography and must be installed on your computer in order to be used for authentication purposes.  Credential Type: Required Which Credential type should I select?
help context for ID proofing  ID Proofing Options: Required Which ID Verification Option?
Please create a password that will be used now and throughout the credentialing process. Enter that password in the Create Password field and enter the exact same password in the Confirm Password field. Remember this password as you will need it in the weeks to come when your credentials are actually issued to you. Please be certain to protect this password do not share it with anyone. The password you create must follow these requirements: <li>The password is case sensitive</li> <li>The password must have a minimum length of 12 characters</li> <li>Password must have at least one Letter</li> <li>Password must have at least one Special Character</li> <li>Password must have at least one Uppercase</li> <li>Password must have at least one Lowercase</li> <li>Password must not contain more than two repeating characters</li> <li>Password must have at least one Number </li>  Create Password: Required
Confirm Password: Required

Authentication Questions

Please answer the following questions, Answers will be automatically converted to upper-case.

Security Question 1: Required Required
Security Question 2: Required Required
Please enter any notes to the NRC program sponsor here to facilitate credential approval. If instructed to provide additional information, include that here as well.  Applicant Notes: Required
Requiredindicates a required field indicates a required field