Form 4130-1 Grazing Schedule and Grazing Application

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UNITED STATES
DEPARTMENT OF THE INTERIOR
BUREAU OF LAND MANAGEMENT

Form 4130-1
(November 2009)

FORM APPROVED
OMB NO. 1004–0041
Expires: July 31, 2011

FOR BLM USE ONLY

GRAZING SCHEDULE
GRAZING APPLICATION

State
Office

Name (last, first, middle initial)

Operator No.

Address (include street, city, State, and zip code)

Schedule No.
Billing Code
Special Bill Code

I hereby apply for the following grazing use on the public lands and/or other lands administered by the Bureau of
Land Management (BLM).
(1)

LINE
NO.

(2)

(3)

ALLOTMENT

PASTURE

NAME

NO.

NO.

(4)

(5)

LIVESTOCK
NUMBER

KIND

BEGIN

(6)

(7)

(8)

(9)

PERIOD

%
PL
USE

T
U

AUM’S

END

Show your recorded brands, earmarks, and wattles
conservation and protection of the public lands;
Show reason for nonuse, if requested:
or other reasons beyond control of the operator; or
livestock disease or quarantine.

annual fluctuation of livestock operations;

Signature

Reason for nonuse:

financial

Date

Approved

Disapproved (Decision Required)

Signature of BLM

Date

Title 18 U.S.C. Section 1001, 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.
(See terms and conditions on page 2)

TERMS AND CONDITIONS
(See 43 CFR 4100)
1. Grazing permit or lease terms and conditions and the fees charged for grazing use are established in accordance with all the provisions of the grazing
regulations now or hereafter approved by the Secretary of the Interior.
2. They are subject to cancellation, in whole or in part, at any time because of:
a. Noncompliance by the permittee/lessee with rules and regulations.
b. Loss of control by the permittee/lessee of all or a part of the property upon which it is based.
c. A transfer of grazing preference by the permittee/lessee to another party.
d. A decrease in the lands administered by the Bureau of Land Management within the allotment(s) described.
e. Repeated willful unauthorized grazing use.
3. They are subject to the terms and conditions of allotment management plans if such plans have been prepared. Allotment management plans must be
incorporated in permits or leases when completed.
4. Those holding permits or leases must own or control and be responsible for the management of livestock authorized to graze.
5. The BLM may require counting and/or additional or special marking or tagging of the livestock authorized to graze.
6. The permittee’s/lessee’s grazing case file is available for public inspection as required by the Freedom of Information Act.
7. Grazing permits or leases are subject to the nondiscrimination clauses set forth in Executive Order 11246 of September 24, 1964, as amended. A copy
of this order may be obtained from the BLM.
8. Livestock grazing use that is different from that authorized by a permit or lease must be applied for prior to the grazing period and must be filed with
and approved by the BLM before grazing use can be made.
9. Billing notices are issued which specify fees due. Billing notices, when paid, become a part of the grazing permit or lease. Grazing use cannot be
authorized during any period of delinquency in the payment of amounts due, including settlement for unauthorized use.
10. Grazing fee payments are due on the date specified on the billing notice and must be paid in full within 15 days of the due date, except as otherwise
provided in the grazing permit or lease. If payment is not made within that time frame, a late fee (the greater of $25 or 10 percent of the amount owed
but not more than $250) will be assessed.
11. Member of, or Delegate to, Congress or Resident Commissioner, after his election or appointment, or either before or after he has qualified, and
during his continuance in office, and no officer, agent, or employee of the Department of the Interior, other than members of Advisory committees
appointed in accordance with the Federal Advisory Committee Act (5 U.S.C. App.1) and Sections 309 of the Federal Land Policy and Management Act
of 1976 (43 U.S.C. 1701 et seq.) will be admitted to any share or part in a permit or lease, or derive any benefit to arise therefrom; and the provisions of
Section 3741 Revised Statutes (41 U.S.C. 22; 18 U.S.C. Sections 431-433, and 43 CFR Part 7), enter into and form a part of a grazing permit or lease,
so far as the same may be applicable.
NOTICES
The Privacy Act of 1974 and the regulations at 43 CFR 2.48 (d) provide that you be furnished the following information in connection with information
required by this permit.
AUTHORITY: Taylor Grazing Act, 43 U.S.C. 315, 316; Federal Land Policy and Management Act, 43 U.S.C. 1701; and Public Rangelands
Improvement Act of 1978, 43 U.S.C. 1901, and 43 U.S.C. 1181d.
PRINCIPAL PURPOSE: The information will be used to process your application for change in grazing use on the public lands.
ROUTINE USES: (1) This information is being collected to determine if the applied for use is within the applicant’s grazing preference to use the
land or resources. (2) This information will be used to calculate your grazing billing. (3) Documentation for public information in support of notations
made on land status records for management, disposal, and use of public lands and resources. (4) Information from the record and/or the record will be
transferred to appropriate Federal agency when concurrence is required prior to granting a preference to use public lands or resources. (5) Transfer to
the U.S. Department of Justice in the event of litigation involving the records or the subject matter of the records, and transfers to Federal, State, local
or foreign agencies, when relevant to civil, criminal or regulatory investigations or prosecution.
EFFECT OF NOT PROVIDING INFORMATION: Disclosure of the information is required to obtain a benefit, in accordance with Sections 3 and
15 of the Taylor Grazing Act, and Section 302 of the Federal Land Policy and Management Act.
The Paperwork Reduction Act of 1995 requires us to inform you that:
BLM collects this information to authorize the right to graze livestock on public lands.
Response to this request is required under 43 CFR 4130.1-1 and 4130.4.
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 15 minutes 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 (1004-0041), Bureau Information Collection Clearance
Officer (WO-630), 1849 C Street, N.W., Washington, D.C. 20240.

(Form 4130-1, page 2)