Form 2930-1 Special Recreation Application

Form 2930-1
(June 2010)

UNITED STATES
DEPARTMENT OF THE INTERIOR
BUREAU OF LAND MANAGEMENT

FORM APPROVED
OMB NO.
Expires:

SPECIAL RECREATION PERMIT APPLICATION
(43 U.S.C 1201; 43 U.S.C. 1701; 16 U.S.C. 460L-6(a); and 43 CFR Group 2930)
Instructions: Complete and return to appropriate BLM Office. (Use additional sheets, as necessary.)
2. Name of Business
Permit Renewal
New Application
1.
or Organization
3. First
Name

Last
Name

Permit No.
Type or Print Plainly in Ink

4. E-mail
address
6. Phone No. (include area code)

5. Address
7. FAX No. (include area code)
ST

City
9. Applicant is:

8. Web site

Zip
Corporation

Individual

Gov't Agency

(If corporation, attach copy of Articles of Incorporation and Certificate unless already on file.)
10. Name(s) and phone number(s) (include area code(s)) of person(s) authorized to conduct business with BLM concerning the permit

11. Application is for (check all that apply)

Competitive Event

Commercial

Organized Group

Vending

(Definitions of these permit types are provided on the reverse side of this form)
12. To use the following public lands/related waters (provide name, legal description and/or attach map or GIS data file as required by issuing BLM Office).

13. For the following purpose: (Attach a complete Operations Plan as required by the issuing BLM Office).

14. Dates of proposed use: Beginning Date:
Check if applying for a multiple year
permit, subject to annual authorization.

Ending Date:
Other schedule:

15. Do you have a permit with BLM/USFS/NPS?

Yes

No

15a. Have you had a permit previously?

Yes

No

15b. Have you ever been denied or had a permit revoked?

Yes

No

15c. Have you forfeited a bond or other security?

Yes

No

15d. Do you have any unresolved, criminal, civil or
administrative actions related to a permit or the activities
you plan to conduct under this permit?

Yes

No

15e. Have you been convicted, or paid a fine, or forfeited a bond,
for violations regarding natural resources, cultural resources or any
activity related to your proposal?
No
Yes

If the answers to any of the above questions is, "Yes:" Provide a detailed explanation on a separate piece of paper.
16. Certification of Information: I CERTIFY the information in this application and supporting documents is true, complete, and correct to the best of my
knowledge and belief and is given in good faith.
I acknowledge that I (we) am (are) required to comply with any conditions or stipulations required by the BLM, including but not limited to
the General Terms listed on page three of this form.

(Signature of Applicant)

(Date)

Title 18 U.S.C. Section 1001 and Title 43 U.S.C. Section 1212 makes it a crime for any person knowingly and willfully to make to any department or
agency of the United States any false, fictitious, or fraudulent statements or representations as to any matter within its jurisdiction.

Definitions
Commercial Use is defined as recreational use of the public lands and related waters for business or financial gain. When any person, group,
or organization makes or attempts to make a profit, receive money, amortize equipment, or obtain goods or services, as compensation from
participants in recreational activities occurring on public lands, the use is considered commercial. An activity, service, or use is commercial
if anyone collects a fee or receives other compensation that is not strictly a sharing of, or is in excess of, actual expenses incurred for the
purposes of the activity, service or use. Commercial use is also characterized by situations where a duty of care or expectation of safety is
owed participants as a result of compensation. It may also be characterized by public advertising for participants. Use by scientific,
educational, and therapeutic institutions or non-profit organizations is considered commercial when the above criteria are met and subject to a
permit when the above conditions exist. Non-profit status of any group or organization does not, in itself, determine whether an event or
activity arranged by such a group or organization is noncommercial. Profit-making organizations are automatically classified as commercial,
even if that part of their activity covered by the permit is not profit-making.
Financial Gain occurs when an individual or entity receives or attempts to receive money, donations, gratuities, or gifts, amortizes
equipment, or barters for goods or services.
Competitive Use means any organized, sanctioned, or structured use, event, or activity on public land in which two or more contestants
compete and any of the following elements apply: (1) Participants register, enter, or complete an application for the event; or (2) A
predetermined course or area is designated. It also means one or more individuals contesting an established record such as speed or
endurance.
Organized Group Activity or Event means a structured, ordered, consolidated, or scheduled event or occupation of public lands for the
purpose of recreational use that is not commercial or competitive, and which BLM has determined needs a special recreation permit based on
planning decisions, resource concerns, potential user conflicts, or public health and safety.
Vending means selling or renting recreation related goods or services such as firewood, equipment repair, shuttles, rentals, etc. on the public
lands or related waters.
NOTICES
The Privacy Act of 1974 and 43 CFR 2.48(d) require that you be furnished the following information:

AUTHORITY:

43 U.S.C. 1201; 43 CFR Group 2930.

PRINCIPAL PURPOSE:
BLM will use your information to determine whether or not to issue you a Special Recreation Permit. BLM will use some of the information to
determine your qualifications for the permit and other information to determine the merits of your proposal.
ROUTINE USES:

BLM will disclose the information in accordance with the regulations at 43 CFR 2.56(d).

EFFECT OF NOT PROVIDING INFORMATION:
Disclosing the information is necessary to receive a benefit. Not discolosing the information may result in BLM rejecting your application.
Paperwork Reduction Act of 1995 (PRA) Statement:
The PRA (44 U.S.C. 3501 et seq.) requires us to inform you that BLM collects this information to determine whether or not to issue you a
Special Recreation Permit. Responses are required to obtain a benefit. Noproprietary information is collected. An agency may not conduct or
sponsor, and you are not required to respond to, a collection of information unless it displays a currently valid OMB Control Number.
BURDEN HOURS STATEMENT
Public reporting burden for this form is estimated to average 4 hours per response, including 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, (1004-0119), Bureau Information Collection
Clearance Officer (WO-630), 1849 C Street, NW, Mail Stop 401 LS, Washington, D.C. 20240.

(Form 2930-1, page 2 of 3)

General Terms.
a. The permittee shall comply with all Federal, State, and local laws; ordinances; regulations; orders; postings; or written requirements
applicable to the area or operations covered by the SRP. The permittee shall ensure that all persons operating under the authorization
have obtained all required Federal, State, and local licenses or registrations. The permittee shall make every reasonable effort to ensure
compliance with these requirements by all agents of the permittee and by all clients, customers, participants, or spectators under the
permittee's supervision.
b. An SRP authorizes special uses of the public lands and related waters and, should circumstances warrant, the permit may be
modified by the BLM at any time, including modification of the amount of use. The authorized officer may suspend or terminate an
SRP if necessary to protect public resources, health, safety, the environment, or because of non-compliance with permit stipulations.
Actions by the BLM to suspend or terminate an SRP are appealable.
c. No value shall be assigned to or claimed for the permit, or for the occupancy or use of Federal lands or related waters granted
thereupon. The permit privileges are not to be considered property on which the permittee shall be entitled to earn or receive any
return, income, price, or compensation. The use of a permit as collateral is not recognized by the BLM.
d. Unless expressly stated, the SRP does not create an exclusive right of use of an area by the permittee. The permittee shall not
interfere with other valid uses of the federal land by other users. The United States reserves the right to use any part of the area for any
purpose.
e. The permittee or permittee's representative may not assign, contract, or sublease any portion of the permit authorization or interest
therein, directly or indirectly, voluntarily or involuntarily. However, contracting of equipment or services may be approved by the
authorized officer in advance, if necessary to supplement a permittee's operations. Such contracting should not constitute more than
half the required equipment or services for any one trip or activity and the permittee must retain operational control of the permitted
activity. If equipment or services are contracted, the permittee shall continue to be responsible for compliance with all stipulations and
conditions of the permit.
f. All advertising and representations made to the public and the authorized officer must be accurate. Although the addresses and
telephone numbers of the BLM may be included in advertising materials, official agency symbols may not be used. The permittee shall
not use advertising that attempts to portray or represent the activities as being conducted by the BLM. The permittee may not portray
or represent the permit fee as a special federal user's tax. The permittee must furnish the authorized officer with any current brochure
and price list if requested by the authorized officer.
g. The permittee assumes responsibility for inspecting the permitted area for any existing or new hazardous conditions, e.g., trail and
route conditions, land slides, avalanches, rocks, changing water or weather conditions, falling limbs or trees, submerged objects,
hazardous flora/fauna, abandoned mines, or other hazards that present risks for which the permittee assumes responsibility.
h. In the event of default on any mortgage or other indebtedness, such as bankruptcy, creditors shall not succeed to the operating rights
or privileges of the permittee's SRP.
i. The permittee cannot, unless specifically authorized, erect, construct, or place any building, structure, or other fixture on public
lands. Upon leaving, the lands must be restored as nearly as possible to pre-existing conditions.
j. The permittee must present or display a copy of the SRP to an authorized officer's representative, or law enforcement personnel upon
request. If required, the permittee must display a copy of the permit or other identification tag on equipment used during the period of
authorized use.
k. The authorized officer, or other duly authorized representative of the BLM, may examine any of the records or other documents
related to the permit, the permittee or the permittee's operator, employee, or agent for up to three years after expiration of the permit.
l. The permittee must submit a post-use report to the authorized officer according to the due dates shown on the permit. If the post-use
report is not received by the established deadline, the permit will be suspended and/or late fees assessed.
m. The permittee shall notify the authorized officer of any incident that occurs while involved in activities authorized by this permit,
which result in death, personal injury requiring hospitalization or emergency evacuation, or in property damage greater than $2,500
(lesser amounts if established by State law). Reports should be submitted within 48 hours in the case of death or injury, or 10 days in
accidents involving property damage.
Form 2930-1, page 3 of 3