FS-2700-35(c) Outfitter/Guide River Trip Ticket Request

FS-2700-35(c) (05/09)

OMB 0596-0082

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UNIT GRAPHIC INSERTED HERE

INSERT UNITS NAME HERE> OUTFITTER/GUIDE

RIVER TRIP TICKET REQUEST

Company Name <Insert the Company Name Here > Permit No. <Insert permit No>

Send Trip Ticket to: <Insert the information on sending the trip ticket >

Trip Ticket Start Date < mm/dd/yyyy > Trip End Date < mm/dd/yyyy >

Number of Clients: <Number of Clients>

Sections Used: A: <section name> B: <section name> C: <section name>

Guide Name: < Enter the name of the guide > Camping Yes □ No □

Total Charge for Trip: $ <Charge Amount> Invoice Number: <Invoice number>

Client Name	Client e-mail or Postal Address

Special Notes:

Additional Cc’s: < Additional cc number 1> < Additional cc number 2>

Submitted By: <Name submitting this request> Date: <mm/dd/yyyy>

Tracking Number

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 0596-0082. The time required to complete this information collection is estimated to average ½ hour per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.

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To file a complaint of discrimination, write USDA, Director, Office of Civil Rights, 1400 Independence Avenue, SW, Washington, DC 20250-9410 or call toll free (866) 632-9992 (voice). TDD users can contact USDA through local relay or the Federal relay at (800) 877-8339 (TDD) or (866) 377-8642 (relay voice). USDA is an equal opportunity provider and employer.