3510-2 Phosphate or sodium Use Permit

(Signature of BLM)

NOTICES
The Privacy Act of 1974 and the regulation, in 43 CFR 2.48(d) provide that you be furnished with the following information
required by this application.
AUTHORITY: 30 U.S.C. 181 et seq, 43 U.S.C. 3500
PRINCIPAL PURPOSE: BLM will use the information you provide to determine whether or not to issue you a use permit for
your phosphate or sodium lease and, if you qualify, will issue you the permit on this form.
ROUTINE USES: BLM will disclose information to: (1) appropriate Federal, State, local or foreign agencies, when relevant to
civil, criminal, or regulatory investigations or prosecutions; (2) appropriate Federal agencies when their concurrence is required
before BLM grants a right in public lands or resources: (3) a member of the public in response to a specific request for
Pertinent information; (4) a congressional office in response to an inquiry made at the request of an individual; and (5) to a
consumer reporting agency to expedite collecting debts owed the government.
EFFECT OF NOT PROVIDING INFORMATION: Filing of this information is required to obtain and keep a benefit. If you
do not provide the information, BLM may not issue a use permit to you.
The Paperwork Reduction Act of 1995 requires us to inform you that:
BLM collects this information to comply with the regulations at 43 CFR 3500, which implement the provisions of the Mineral
Leasing Act of 1920, as amended; the Mineral Leasing Act for Acquired Land of 1947; and section 402 of Reorganization Plan
No. 3 1946.
BLM uses this information to determine whether or not you qualify for a use permit for your sodium or phosphate lease.
Response to this request is required to obtain and keep a benefit.
BLM would like you to know that you do not have to respond to this or any other Federal agency-sponsored information
collection unless it displays a currently valid OMB control number.
BURDEN HOURS STATEMENT: Public reporting burden for this form is estimated to average 1 hour per response,
including the time for reviewing instructions, gathering, and maintaining data, and completing and reviewing the form. Direct
comments regarding the burden estimate or any other aspect of this form to U.S. Department of the Interior, Bureau of Land
Management (1004-0121), Bureau Information Collection Clearance Officer, (WO-630), 1849 C Street, N.W., Mail Stop
401LS, Washington, D.C. 20240.

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(Form 3510-2, page 3)