Form FS-2200-1 Refund Credit or Transfer Application

USDA Forest Service OMB No. 0596-0003

Expires ##/####

Refund, Credit, or Transfer Application

Permittee (Name & Mailing Address)      

Permit Number      

Date      

National Forest or Grassland      

Ranger District      

APPLICATION IS HEREBY MADE FOR: (Check One) Credit on next year’s fees for unused portion of       permitted use. (Year) Refund of fees for unused portion of       permitted use. (Year) Transfer credit to the account of      

PERMITTEE ACTION

FOREST SERVICE ACTION

Allotment

Cattle Horses Sheep

No. of Head

Period Range Not Used

Permitted HMs Not Used

Rate Per HM

AmounT of

Computed

Checked

From

To

Credit

By

By

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

Total Credit or Refund

Posted to Card       (Date & Initials)

REASON FOR LESS USE THAN PERMITTED:      

Signature of Permittee      

Title      

Date      

RECOMMENDATION: (Check One)

APPROVAL

DISAPPROVAL (Give reasons for either recommendation)

     

Signature of Recommending Officer      

Name (print)      

Title      

Date      

ACTION: (Check One)

APPROVED

DISAPPROVED (If disapproved, give reasons)

     

Signature of Authorized Officer      

Name (print)      

Title      

Date      

FS-2200-01 (05/2009)

Microsoft Word 2000

According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0596-0003. The time required to complete this information collection is estimated to average 20 minutes, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.