Form 7-2578 Religious or Charitable Identification Sheet

7-2578 (07-07)
Bureau of Reclamation

OMB Control No.: 1006-0023
OMB Expiration Date: December 31, 2009

RELIGIOUS OR CHARITABLE ORGANIZATION IDENTIFICATION SHEET
For Determining if Your Organization is a Eligible for Special Application of the
Acreage Limitation Provisions Under Section 219 of the Reclamation Reform Act of 1982 (RRA)
[Use of this Sheet is to be initiated by Reclamation only.]
For Reclamation Use Only
Date requested: __________________________________________________
District name: ____________________________________________________
Religious or Charitable Organization name:

____________________________

TO BE COMPLETED BY RELIGIOUS OR CHARITABLE ORGANIZATION
(Please refer to the instructions provided on the other side of this form.)
1. Religious or charitable organization name: __________________________________
2. Organization address:

_________________________________________________
________________________________________________

3. Total landholding in this district (in acres): ____________
4. Does your organization have tax exempt status under section 501 of the Internal Revenue Code?
YES
NO
If you answered “YES,” provide documentation confirming your tax exempt status with this completed identification sheet.
Acceptable forms of proof include, but are not limited to:

•
•
•

Your organization’s tax exemption letter from the IRS,
Your central organization’s IRS group exemption letter, or
Your organization’s most recent Federal income tax return.

5. If you answered “NO” to number 4 above, proceed to number 6.
If you answered “YES” to number 4 above, answer all of the following questions:

(a) Is any part of your organization’s agricultural produce or the proceeds of the sales of such produce used for other than
charitable purposes?

If the answer is “YES,” explain how the produce and proceeds are used:

YES

NO

(b) Is any land held by your organization operated or leased by a party other than your organization, a subdivision of the
organization, or a more central organization of the same affiliation? If the answer is “YES,” explain who operates or
leases the land.
YES
NO

(c) Does any part of your organization’s net earnings accrue to the benefit of any private shareholder or individual? If the
answer is “YES,” explain who benefits from the organization’s net earnings.
YES
NO

(d) Does your organization hold land in any other district(s) subject to the acreage limitation provisions? If so, list the
district(s) where land is held and the number of acres held in the district(s). If you are unsure of whether another
district is subject to the acreage limitation provisions of Federal reclamation law, contact your appropriate
Reclamation office. Use attachments if necessary.
YES
NO

ORGANIZATION COPY

Page 1 of 2

6. If you answered “YES” to number 4 above AND provided the information/documentation requested in numbers 4 AND 5, skip
number 6 and proceed to the attestation section below.

If you answered “NO” to number 4 above, answer the following questions:
(a) Did your organization receive Reclamation irrigation water on or before October 1, 1981?
YES
NO
If “YES,” provide the date your organization first received Reclamation irrigation water and the name of the
district where that water was received:
Date _____________________________

District: ______________________________________________

(b) Does your organization hold land in any other district(s) subject to the acreage limitation provisions? If so,

list the district(s) where land is held and the number of acres held in the district(s). If you are unsure of
whether another district is subject to the acreage limitation provisions of Federal reclamation law, contact
your appropriate Reclamation office. Use attachments if necessary.
YES
NO

If you completed number 6 above, your organization may not be eligible for special application of the acreage
limitation provisions under section 219 of the RRA and may be determined to be a limited recipient.

Please attest to the following:
I (we) attest that the information provided herein is true, accurate, and complete to the best of my (our) knowledge.
Name:

____________________________________________________________

Signature:

____________________________________________________________

Date:

____________________________________________________________

Address:

____________________________________________________________

Relationship to organization: __________________________________________________
Telephone number where you can be contacted: __________________________________
RETURN THIS IDENTIFICATION SHEET TO THE ISSUING RECLAMATION OFFICE.
See reverse side for instructions and Paperwork Reduction Act of 1995 and Privacy Act of 1974 system of records information.

ORGANIZATION COPY

Page 2 of 2

Paperwork Reduction Act
This information is being collected to establish landholder compliance with Federal reclamation law. Response to this request is
mandatory in accordance with Public Law 97-293 and 43 CFR 426.18. Public reporting burden for this form is estimated to
average 5 minutes per response. An agency may not conduct or sponsor, and a person is not required to respond to, a
collection of information unless it displays a currently valid Office of Management and Budget (OMB) control number.
Direct comments regarding the burden estimated or any other aspect of these forms to Manager, Land Resources Office,
Code 84-53000, U.S. Bureau of Reclamation, PO Box 25007, Denver CO 80225.

INSTRUCTIONS FOR COMPLETION
GENERAL Instructions
• When Reclamation has identified an organization that may be eligible for special application of the acreage limitation provisions
under section 219 of the RRA, Reclamation will determine if the “Religious or Charitable Organization Identification Sheet”
(Sheet) should be completed by the organization. Reclamation will send this Sheet directly to the organization.
• Press firmly when writing to ensure that all copies are legible.
• Visit www.usbr.gov/rra for more information.
RECLAMATION Instructions
• “For Reclamation Use Only” block: Complete all information.
• For recordkeeping purposes, retain the top half-sheet copy (“Originator Copy”) of the Sheet at the time of issuance.
• When the organization has completed and returned the Sheet to Reclamation:
o Ensure the Sheet is complete.
o Retain the “Reclamation Copy.”
o Provide the “District Copy” to the appropriate district office.
ORGANIZATION Instructions
• Numbers 1 through 3: Enter the requested information.
• Number 4: Provide the requested documentation if the answer to number 4 is “YES.” The requested documentation must
accompany this completed identification sheet.
• Number 5: Provide the requested information (parts [a] through [d]) if the answer to number 4 is “YES.” Proceed to number 6 if
the answer to number 4 is “NO.”
• Number 6: Provide the requested information (parts [a] and [b]) if the answer to number 4 is “NO.” Proceed to the attestation
section if the answer to number 4 is “YES” AND you provided the information/documentation requested in numbers 4 and 5.
• Complete the attestation section (name, signature, date, address, relationship to the organization, and telephone number).
• Retain the “Organization Copy”
• Return the “Reclamation Copy” and the “District Copy” to the Reclamation office that issued this Sheet.

This report is required by Public Law 97-293. Failure to complete this form can result in the determination that your entity
is a limited recipient with a zero acre nonfull-cost entitlement. Information obtained in this form is protected by the Privacy Act
of 1974, system of records notice INTERIOR/WBR-31, and will be used to administer the acreage limitation provisions of
Federal reclamation law. The Secretary of the Interior or the district may require additional information in order to administer
these laws.

7-25XX (07-07)
Bureau of Reclamation

OMB Control No.: 1006-00XX
OMB Expiration Date: December 31, 2009

RELIGIOUS OR CHARITABLE ORGANIZATION IDENTIFICATION SHEET
For Determining if Your Organization is a Eligible for Special Application of the
Acreage Limitation Provisions Under Section 219 of the Reclamation Reform Act of 1982 (RRA)
[Use of this Sheet is to be initiated by Reclamation only.]
For Reclamation Use Only
Date requested: __________________________________________________
District name: ____________________________________________________
Religious or Charitable Organization name:

____________________________

Paperwork Reduction Act
This information is being collected to establish landholder compliance with Federal reclamation law. Response to this
request is mandatory in accordance with Public Law 97-293 and 43 CFR 426.18. Public reporting burden for this form is
estimated to average 5 minutes per response. An agency may not conduct or sponsor, and a person is not required to
respond to, a collection of information unless it displays a currently valid Office of Management and Budget (OMB) control
number. Direct comments regarding the burden estimated or any other aspect of these forms to Manager, Land Resources
Office, Code D-5300, U.S. Bureau of Reclamation, PO Box 25007, Denver CO 80225.

ORIGINATOR COPY